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Reed GW, Harmon EK, Harb S, Yun J, Krishnaswamy A, Abraham WT, Kapadia S. Design and Rationale of the V-Wave Shunt MitraClip Study. Am J Cardiol 2024; 227:29-36. [PMID: 38950689 DOI: 10.1016/j.amjcard.2024.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 06/03/2024] [Accepted: 06/10/2024] [Indexed: 07/03/2024]
Abstract
Heart failure (HF) and moderate-to-severe mitral regurgitation (MR) with residual elevations in left atrial pressure (LAP) after MitraClip may remain symptomatic and experience subsequent HF readmissions. The V-Wave interatrial shunt system is a permanent interatrial septal implant that shunts blood from the left-to-right atrium and serves to continuously unload the left atrium. Although the V-Wave shunt has previously been studied in patients with HF, the safety and feasibility of its deployment at the time of the MitraClip procedure is unknown. The V-Wave Shunt MitraClip Study (NCT04729933) is an early feasibility study that aims to demonstrate the safety and efficacy of implantation of the V-Wave shunt device at the time of MitraClip procedure. Patients with moderate-to-severe secondary MR with left ventricular ejection fraction 20% to 50% and New York Heart Association functional class III/IV symptoms despite optimal medical therapy, residual mean LAP ≥20 mm Hg after MitraClip, and mean LAP-right atrial pressure difference ≥5 mm Hg are included. The primary safety end point is a composite outcome of all-cause death, stroke, myocardial infarction device embolization, cardiac tamponade, or device-related re-intervention or surgery at 30 days. Patients will be followed up to 5 years. Enrollment is ongoing, with 30-day results expected by the end of 2024. The V-Wave Shunt Mitraclip Study aims to demonstrate the safety and efficacy of the implantation of the V-Wave interatrial shunt device at the time of index MitraClip placement which may serve as an adjunctive method by which continuous left atrial unloading may be achieved.
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Affiliation(s)
- Grant W Reed
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
| | - Evan K Harmon
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Serge Harb
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - James Yun
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - William T Abraham
- Division of Cardiovascular Medicine, Ohio State University, Columbus, Ohio
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
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2
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Chowdhury SM, Atz AM, Graham EM, Bandisode VM, Rhodes JF, Nutting AC, Taylor C, Savage A, Hassid M, Kavarana M, Menick D. Low Ventricular Stiffness Is Associated With Suboptimal Outcomes in Patients With a Single Right Ventricle After the Fontan Operation: A Novel Phenotype. J Am Heart Assoc 2024; 13:e035601. [PMID: 39189484 DOI: 10.1161/jaha.124.035601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 07/09/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND Despite a rigorous screening process, including cardiac catheterization, a subset of patients with a single right ventricle (SRV) demonstrates suboptimal short-term outcomes after the Fontan operation. The goal of this study was to perform a comprehensive assessment of diastolic function in pre-Fontan patients with an SRV using invasive reference-standard measures and determine their associations with post-Fontan outcomes. METHODS AND RESULTS Children aged 2 to 6 years with SRV physiology undergoing pre-Fontan heart catheterization were recruited prospectively. Patients were divided into those who had an optimal or suboptimal outcome. A suboptimal outcome was defined as length of stay ≥14 days or heart transplant/cardiac death in first year after Fontan. Patients underwent pressure-volume loop analysis using reference-standard methods. The measure of ventricular stiffness, β, was obtained via preload reduction. Cardiac magnetic resonance imaging for extracellular volume and serum draws for matrix metalloproteinase activity were performed. Of 19 patients with an SRV, 9 (47%) had a suboptimal outcome. Mean age was 4.2±0.7 years. Patients with suboptimal outcomes had lower ventricular stiffness (0.021 [0.009-0.049] versus 0.090 [0.031-0.118] mL-1; P=0.02), lower extracellular volume (25% [28%-32%] versus 31% [28%-33%]; P=0.02), and lower matrix metalloproteinase-2 (90 [79-104] versus 108 [79-128] ng/mL; P=0.01) compared with patients with optimal outcomes. The only invasive measure that had an association with suboptimal outcome was β (P=0.038). CONCLUSIONS Patients with an SRV with suboptimal outcome after the Fontan operation had lower ventricular stiffness and evidence of maladaptive extracellular matrix metabolism compared with patients with optimal outcome. This appears to be a novel phenotype that may have important clinical implications and requires further study.
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Affiliation(s)
- Shahryar M Chowdhury
- Department of Pediatrics, Division of Cardiology Medical University of South Carolina Charleston SC USA
| | - Andrew M Atz
- Department of Pediatrics, Division of Cardiology Medical University of South Carolina Charleston SC USA
| | - Eric M Graham
- Department of Pediatrics, Division of Cardiology Medical University of South Carolina Charleston SC USA
| | - Varsha M Bandisode
- Department of Pediatrics, Division of Cardiology Medical University of South Carolina Charleston SC USA
| | - John F Rhodes
- Department of Pediatrics, Division of Cardiology Medical University of South Carolina Charleston SC USA
| | - Arni C Nutting
- Department of Pediatrics, Division of Cardiology Medical University of South Carolina Charleston SC USA
| | - Carolyn Taylor
- Department of Pediatrics, Division of Cardiology Medical University of South Carolina Charleston SC USA
| | - Andrew Savage
- Department of Pediatrics, Division of Cardiology Medical University of South Carolina Charleston SC USA
| | - Marc Hassid
- Department of Anesthesia Medical University of South Carolina Charleston SC USA
| | - Minoo Kavarana
- Department of Surgery Medical University of South Carolina Charleston SC USA
| | - Donald Menick
- Department of Medicine, Division of Cardiology Medical University of South Carolina Charleston SC USA
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Deak A, Zaidi SM, Gangireddy C, Cronin E, Hamad E, Fabrizio C, Bhatia-Patel S, Rakita V, Whitman IR. Mid-term clinical outcomes and cardiac function in patients receiving cardiac contractility modulation. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01900-0. [PMID: 39210240 DOI: 10.1007/s10840-024-01900-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 08/06/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVES To describe the mid-term clinical and functional cardiac contractility modulation therapy (CCM) recipients in an urban population with heart failure. BACKGROUND CCM is a non-excitatory electrical therapy for patients with systolic heart failure with NYHA class III symptoms and ejection fraction (EF) 25-45%. How CCM affects a broad range of clinical measures, including diastolic dysfunction (DD) and weight change, is unexplored. METHODS We reviewed 31 consecutive patients at our center who underwent CCM implant. NYHA class, hospitalizations, ejection fraction (EF), diastolic function, and weight were compared pre- and post-CCM implant. RESULTS Mean age and follow-up time was 63 ± 10 years and 1.4 ± 0.8 years, respectively. Mean NYHA class improved by 0.97 functional classes (p < 0.001), and improvement occurred in 68% of patients. Mean annualized hospitalizations improved (0.8 ± 0.8 vs. 0.4 ± 1.0 hospitalizations/year, p = 0.048), and after exclusion of a single outlier, change in annualized days hospitalized also improved (total cohort 3.8 ± 4.7 vs. 3.7 ± 14.8 days/year; p = 0.96; after exclusion, 3.8 ± 4.7 vs. 1.1 ± 1.9 days/year, p < 0.001). Mean EF improved by 8% (p = 0.002), and among those with DD pre-CCM, mean DD improvement was 0.8 "grades" (p < 0.001). Mean weight change was 8.5 pounds lost, amounting to 4% of body weight (p = 0.002, p = 0.002, respectively), with 77% of patients having lost weight after CCM. Five patients (16%) experienced procedural complications; incidence skewed toward early implants. CONCLUSION In an observational cohort, CCM therapy resulted in improvement in NYHA class, hospitalizations, systolic and diastolic function, and weight.
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Affiliation(s)
- Andrew Deak
- Department of Medicine, Section of Cardiology, Parkinson Pavilion, 9th Floor, 3401 North Broad Street, Philadelphia, PA, 19140, USA
| | - Syed M Zaidi
- Department of Medicine, Section of Cardiology, Parkinson Pavilion, 9th Floor, 3401 North Broad Street, Philadelphia, PA, 19140, USA
| | - Chethan Gangireddy
- Department of Medicine, Section of Cardiology, Parkinson Pavilion, 9th Floor, 3401 North Broad Street, Philadelphia, PA, 19140, USA
| | - Edmond Cronin
- Department of Medicine, Section of Cardiology, Parkinson Pavilion, 9th Floor, 3401 North Broad Street, Philadelphia, PA, 19140, USA
| | - Eman Hamad
- Department of Medicine, Section of Cardiology, Parkinson Pavilion, 9th Floor, 3401 North Broad Street, Philadelphia, PA, 19140, USA
| | - Carly Fabrizio
- Department of Medicine, Section of Cardiology, Parkinson Pavilion, 9th Floor, 3401 North Broad Street, Philadelphia, PA, 19140, USA
| | - Sanjana Bhatia-Patel
- Department of Medicine, Section of Cardiology, Parkinson Pavilion, 9th Floor, 3401 North Broad Street, Philadelphia, PA, 19140, USA
| | - Val Rakita
- Department of Medicine, Section of Cardiology, Parkinson Pavilion, 9th Floor, 3401 North Broad Street, Philadelphia, PA, 19140, USA
| | - Isaac R Whitman
- Department of Medicine, Section of Cardiology, Parkinson Pavilion, 9th Floor, 3401 North Broad Street, Philadelphia, PA, 19140, USA.
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Venet M, Malik A, Gold S, Zhang N, Gopaul J, Dauz J, Yazaki K, Ponzoni M, Coles JG, Maynes JT, Sun M, Howell A, Chaturvedi R, Mertens L, Mroczek D, Uike K, Baranger J, Friedberg MK, Villemain O. Impact of Right Ventricular Pressure Overload on Myocardial Stiffness Assessed by Natural Wave Imaging. JACC Cardiovasc Imaging 2024:S1936-878X(24)00284-5. [PMID: 39177563 DOI: 10.1016/j.jcmg.2024.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 05/29/2024] [Accepted: 06/28/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Right ventricular (RV) hemodynamic performance determines the prognosis of patients with RV pressure overload. Using ultrafast ultrasound, natural wave velocity (NWV) induced by cardiac valve closure was proposed as a new surrogate to quantify myocardial stiffness. OBJECTIVES This study aimed to assess RV NWV in rodent models and children with RV pressure overload vs control subjects and to correlate NWV with RV hemodynamic parameters. METHODS Six-week-old rats were randomized to pulmonary artery banding (n = 6), Sugen hypoxia-induced pulmonary arterial hypertension (n = 7), or sham (n = 6) groups. They underwent natural wave imaging, echocardiography, and hemodynamic assessment at baseline and 6 weeks postoperatively. The authors analyzed NWV after tricuspid and after pulmonary valve closure (TVC and PVC, respectively). Conductance catheters were used to generate pressure-volume loops. In parallel, the authors prospectively recruited 14 children (7 RV pressure overload; 7 age-matched control subjects) and compared RV NWV with echocardiographic and invasive hemodynamic parameters. RESULTS NWV significantly increased in RV pressure overload rat models (4.99 ± 0.27 m/s after TVC and 5.03 ± 0.32 m/s after PVC in pulmonary artery banding at 6 weeks; 4.89 ± 0.26 m/s after TVC and 4.84 ± 0.30 m/s after PVC in Sugen hypoxia at 6 weeks) compared with control subjects (2.83 ± 0.15 m/s after TVC and 2.72 ± 0.34 m/s after PVC). NWV after TVC correlated with both systolic and diastolic parameters including RV dP/dtmax (r = 0.75; P < 0.005) and RV Ees (r = 0.81; P < 0.005). NWV after PVC correlated with both diastolic and systolic parameters and notably with RV end-diastolic pressure (r = 0.65; P < 0.01). In children, NWV after both right valves closure in RV pressure overload were higher than in healthy volunteers (P < 0.01). NWV after PVC correlated with RV E/E' (r = 0.81; P = 0.008) and with RV chamber stiffness (r = 0.97; P = 0.03). CONCLUSIONS Both RV early-systolic and early-diastolic myocardial stiffness show significant increase in response to pressure overload. Based on physiology and our observations, early-systolic myocardial stiffness may reflect contractility, whereas early-diastolic myocardial stiffness might be indicative of diastolic function.
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Affiliation(s)
- Maelys Venet
- Department of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Bordeaux University Hospital, Department of Pediatric and Adult Congenital Cardiology, Pessac, France; Electrophysiology and Heart Modeling Institute, Institut Hospital-Universitaire Liryc, Fondation Bordeaux Université, Bordeaux, France.
| | - Aimen Malik
- Department of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Samantha Gold
- Department of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Naiyuan Zhang
- Department of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Josh Gopaul
- Department of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - John Dauz
- Department of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kana Yazaki
- Department of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Matteo Ponzoni
- Department of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - John G Coles
- Department of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jason T Maynes
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mei Sun
- Department of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alison Howell
- Department of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rajiv Chaturvedi
- Department of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Luc Mertens
- Department of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Dariusz Mroczek
- Department of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kiyoshi Uike
- Department of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jerome Baranger
- Department of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mark K Friedberg
- Department of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Olivier Villemain
- Department of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Bordeaux University Hospital, Department of Pediatric and Adult Congenital Cardiology, Pessac, France; Electrophysiology and Heart Modeling Institute, Institut Hospital-Universitaire Liryc, Fondation Bordeaux Université, Bordeaux, France. https://twitter.com/Villemain_Team
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5
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Frederiksen PH, Linde L, Gregers E, Udesen NL, Helgestad OK, Banke A, Dahl JS, Jensen LO, Lassen JF, Povlsen AL, Larsen JP, Schmidt H, Ravn HB, Møller JE. Haemodynamic implications of VA-ECMO vs. VA-ECMO plus Impella CP for cardiogenic shock in a large animal model. ESC Heart Fail 2024; 11:2305-2313. [PMID: 38649295 PMCID: PMC11287291 DOI: 10.1002/ehf2.14780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 03/12/2024] [Accepted: 03/16/2024] [Indexed: 04/25/2024] Open
Abstract
AIMS Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) with profound left ventricular (LV) failure is associated with inadequate LV emptying. To unload the LV, VA-ECMO can be combined with Impella CP (ECMELLA). We hypothesized that ECMELLA improves cardiac energetics compared with VA-ECMO in a porcine model of cardiogenic shock (CS). METHODS AND RESULTS Land-race pigs (weight 70 kg) were instrumented, including a LV conductance catheter and a carotid artery Doppler flow probe. CS was induced with embolization in the left main coronary artery. CS was defined as reduction of ≥50% in cardiac output or mixed oxygen saturation (SvO2) or a SvO2 < 30%. At CS VA-ECMO was initiated and embolization was continued until arterial pulse pressure was <10 mmHg. At this point, Impella CP was placed in the ECMELLA arm. Support was maintained for 4 h. CS was induced in 15 pigs (VA-ECMO n = 7, ECMELLA n = 8). At time of CS MAP was <45 mmHg in both groups, with no difference at 4 h (VA-ECMO 64 mmHg ± 11 vs. ECMELLA 55 mmHg ± 21, P = 0.08). Carotid blood flow and arterial lactate increased from CS and was similar in VA-ECMO and ECMELLA [239 mL/min ± 97 vs. 213 mL/min ± 133 (P = 0.6) and 5.2 ± 3.3 vs. 4.2 ± 2.9 mmol/ (P = 0.5)]. Pressure-volume area (PVA) was significantly higher with VA-ECMO compared with ECMELLA (9567 ± 1733 vs. 6921 ± 5036 mmHg × mL/min × 10-3, P = 0.014). Total diureses was found to be lower in VA-ECMO compared with ECMELLA [248 mL (179-930) vs. 506 mL (418-2190); P = 0.005]. CONCLUSIONS In a porcine model of CS, we found lower PVA, with the ECMELLA configuration compared with VA-ECMO, indicating better cardiac energetics without compromising systemic perfusion.
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Affiliation(s)
| | - Louise Linde
- Department of CardiologyOdense University HospitalOdenseDenmark
| | - Emilie Gregers
- Department of Cardiology, Heart CenterCopenhagen University Hospital RigshospitaletCopenhagenDenmark
| | | | | | - Ann Banke
- Department of CardiologyOdense University HospitalOdenseDenmark
| | - Jordi S. Dahl
- Department of CardiologyOdense University HospitalOdenseDenmark
| | - Lisette O. Jensen
- Department of CardiologyOdense University HospitalOdenseDenmark
- Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
| | - Jens F. Lassen
- Department of CardiologyOdense University HospitalOdenseDenmark
| | - Amalie L. Povlsen
- Department of Cardiothoracic AnaesthesiologyOdense University HospitalOdenseDenmark
| | - Jeppe P. Larsen
- Department of Cardiothoracic AnaesthesiologyOdense University HospitalOdenseDenmark
| | - Henrik Schmidt
- Department of Cardiothoracic AnaesthesiologyOdense University HospitalOdenseDenmark
| | - Hanne B. Ravn
- Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
- Department of Cardiothoracic AnaesthesiologyOdense University HospitalOdenseDenmark
| | - Jacob E. Møller
- Department of CardiologyOdense University HospitalOdenseDenmark
- Department of Cardiology, Heart CenterCopenhagen University Hospital RigshospitaletCopenhagenDenmark
- Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
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6
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Meani P, Todaro S, Veronese G, Kowalewski M, Montisci A, Protti I, Marchese G, Meuwese C, Lorusso R, Pappalardo F. Science of left ventricular unloading. Perfusion 2024:2676591241268389. [PMID: 39058419 DOI: 10.1177/02676591241268389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
The concept of left ventricular unloading has its foundation in heart physiology. In fact, the left ventricular mechanics and energetics represent the cornerstone of this approach. The novel sophisticated therapies for acute heart failure, particularly mechanical circulatory supports, strongly impact on the mechanical functioning and energy consuption of the heart, ultimately affecting left ventricle loading. Notably, extracorporeal circulatory life support which is implemented for life-threatening conditions, may even overload the left heart, requiring additional unloading strategies. As a consequence, the understanding of ventricular overload, and the associated potential unloading strategies, founds its utility in several aspects of day-by-day clinical practice. Emerging clinical and pre-clinical research on left ventricular unloading and its benefits in heart failure and recovery has been conducted, providing meaningful insights for therapeutical interventions. Here, we review the current knowledge on left ventricular unloading, from physiology and molecular biology to its application in heart failure and recovery.
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Affiliation(s)
- Paolo Meani
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands
- Thoracic Research Center, Innovative Medical Forum, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Serena Todaro
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Giacomo Veronese
- Anesthesia and Cardiovascular Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mariusz Kowalewski
- Thoracic Research Center, Innovative Medical Forum, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Andrea Montisci
- Cardiothoracic Department, Division of Cardiothoracic Intensive Care, ASST Spedali Civili, Brescia, Italy
| | - Ilaria Protti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Giuseppe Marchese
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Christiaan Meuwese
- Department of Intensive Care and Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands
| | - Federico Pappalardo
- Cardiothoracic and Vascular Anesthesia and Intensive Care, Azienda Ospedaliera Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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7
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Protti I, van Steenwijk MPJ, Meani P, Fresiello L, Meuwese CL, Donker DW. Left Ventricular Unloading in Extracorporeal Membrane Oxygenation: A Clinical Perspective Derived from Basic Cardiovascular Physiology. Curr Cardiol Rep 2024; 26:661-667. [PMID: 38713362 PMCID: PMC11236850 DOI: 10.1007/s11886-024-02067-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE OF REVIEW To present an abridged overview of the literature and pathophysiological background of adjunct interventional left ventricular unloading strategies during veno-arterial extracorporeal membrane oxygenation (V-A ECMO). From a clinical perspective, the mechanistic complexity of such combined mechanical circulatory support often requires in-depth physiological reasoning at the bedside, which remains a cornerstone of daily practice for optimal patient-specific V-A ECMO care. RECENT FINDINGS Recent conventional clinical trials have not convincingly shown the superiority of V-A ECMO in acute myocardial infarction complicated by cardiogenic shock as compared with medical therapy alone. Though, it has repeatedly been reported that the addition of interventional left ventricular unloading to V-A ECMO may improve clinical outcome. Novel approaches such as registry-based adaptive platform trials and computational physiological modeling are now introduced to inform clinicians by aiming to better account for patient-specific variation and complexity inherent to V-A ECMO and have raised a widespread interest. To provide modern high-quality V-A ECMO care, it remains essential to understand the patient's pathophysiology and the intricate interaction of an individual patient with extracorporeal circulatory support devices. Innovative clinical trial design and computational modeling approaches carry great potential towards advanced clinical decision support in ECMO and related critical care.
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Affiliation(s)
- I Protti
- Departments of Cardiology and Intensive Care, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - M P J van Steenwijk
- Departments of Cardiology and Intensive Care, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - P Meani
- Maastricht University Medical Center+, Cardiothoracic Surgery, Heart and Vascular Center, Maastricht, the Netherlands
| | - L Fresiello
- Cardiovascular and Respiratory Physiology, TechMed Center, University of Twente, Hallenweg 5, 7522, NH, Enschede, The Netherlands
| | - C L Meuwese
- Departments of Cardiology and Intensive Care, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - D W Donker
- Cardiovascular and Respiratory Physiology, TechMed Center, University of Twente, Hallenweg 5, 7522, NH, Enschede, The Netherlands.
- Intensive Care Center, University Medical Center Utrecht, Utrecht, the Netherlands.
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8
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Yahagi K, Nishimura G, Kuramoto K, Tsuboko Y, Iwasaki K. Hemodynamics with mechanical circulatory support devices using a cardiogenic shock model. Sci Rep 2024; 14:14125. [PMID: 38898087 PMCID: PMC11187098 DOI: 10.1038/s41598-024-64721-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 06/12/2024] [Indexed: 06/21/2024] Open
Abstract
Mechanical circulatory support (MCS) devices, including veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and Impella, have been widely used for patients with cardiogenic shock (CS). However, hemodynamics with each device and combination therapy is not thoroughly understood. We aimed to elucidate the hemodynamics with MCS using a pulsatile flow model. Hemodynamics with Impella CP, VA-ECMO, and a combination of Impella CP and VA-ECMO were assessed based on the pressure and flow under support with each device and the pressure-volume loop of the ventricle model. The Impella CP device with CS status resulted in an increase in aortic pressure and a decrease in end-diastolic volume and end-diastolic pressure (EDP). VA-ECMO support resulted in increased afterload, leading to a significant increase in aortic pressure with an increase in end-systolic volume and EDP and decreasing venous reservoir pressure. The combination of Impella CP and VA-ECMO led to left ventricular unloading, regardless of increase in afterload. Hemodynamic support with Impella and VA-ECMO should be a promising combination for patients with severe CS.
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Affiliation(s)
- Kazuyuki Yahagi
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Waseda University, 2-2 Wakamatsucho, Shinjuku, Tokyo, 162-8480, Japan
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Gohki Nishimura
- Department of Modern Mechanical Engineering, Graduate School of Creative Science and Engineering, Waseda University, Tokyo, Japan
| | - Kei Kuramoto
- Department of Modern Mechanical Engineering, Graduate School of Creative Science and Engineering, Waseda University, Tokyo, Japan
| | - Yusuke Tsuboko
- Waseda Research Institute for Science and Engineering, Waseda University, Tokyo, Japan
| | - Kiyotaka Iwasaki
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Waseda University, 2-2 Wakamatsucho, Shinjuku, Tokyo, 162-8480, Japan.
- Department of Modern Mechanical Engineering, Graduate School of Creative Science and Engineering, Waseda University, Tokyo, Japan.
- Waseda Research Institute for Science and Engineering, Waseda University, Tokyo, Japan.
- Department of Integrative Bioscience and Biomedical Engineering, Graduate School of Advanced Science and Engineering, Waseda University, Tokyo, Japan.
- Institute for Medical Regulatory Science, Comprehensive Research Organization, Waseda University, Shinjuku, Tokyo, Japan.
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9
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Sato K, Heinsar S, Chan J, Farah SM, Wildi K, Obonyo NG, Liu K, Ainola C, Sato N, Abbate G, Wilson ES, Bouquet M, Hyslop K, Passmore MR, Ijuin S, Ro SK, Fior G, Gandini L, Lundon B, Platts DG, Suen JY, Bassi GL, Fraser JF. A novel echocardiographic parameter considering left ventricular afterload during V-A ECMO support. Eur J Clin Invest 2024:e14263. [PMID: 38849326 DOI: 10.1111/eci.14263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/19/2024] [Accepted: 05/25/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Left ventricular stroke work index (LVSWI) and cardiac power index (CPI) account for the haemodynamic load of the left ventricle and are promising prognostic values in cardiogenic shock. However, accurately and non-invasively measuring these parameters during veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is challenging and potentially biased by the extracorporeal circulation. This study aimed to investigate, in an ovine model of cardiogenic shock, whether Pressure-Strain Product (PSP), a novel speckle-tracking echocardiography parameter, (1) can correlate with pressure-volume catheter-based LVSWI and CPI, and (2) can be load-independent during the flow modification of V-A ECMO. METHODS Nine Dorset-cross ewes (51 ± 4 kg) were included. After cardiogenic shock was induced, full support V-A ECMO (X L/min based on 60 mL/kg/min) commenced. At seven time points during 24-h observation, echocardiographic parameters as well as pressure-volume catheter-based LVSWI and CPI were simultaneously measured with X and following X-1 L/min of ECMO flow. PSP was calculated by multiplying global circumferential strain or global radial strain, and mean arterial pressure, for PSPcirc or PSPrad, respectively. RESULTS PSPcirc showed a stronger correlation with LVSWI (correlation coefficient, CC = .360, p < .001) and CPI (CC = .283, p < .001) than other echocardiographic parameters. The predictability of PSPcirc for pressure-volume catheter-based LVSWI (AUC .82) and CPI (AUC .80) was also higher than other echocardiographic parameters. No statistically significant differences were identified between the two ECMO flow variations in PSPcirc (p = .558). CONCLUSIONS A novel echocardiographic parameter, PSP, may non-invasively predict pressure-volume catheter-based LVSWI and CPI in a load-independent manner in a cardiogenic shock supported by V-A ECMO.
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Affiliation(s)
- Kei Sato
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Silver Heinsar
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Intensive Care Unit, St. Andrews War Memorial Hospital, Brisbane, Queensland, Australia
- Department of Intensive Care, North Estonia Medical Centre, Tallinn, Estonia
| | - Jonathan Chan
- Division of Cardiology, The Prince Charles Hospital, Brisbane, Queensland, Australia
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Samia M Farah
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Karin Wildi
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Nchafatso G Obonyo
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Wellcome Trust Centre for Global Health Research, Imperial College London, London, UK
- Initiative to Develop African Research Leaders (IDeAL)/KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Keibun Liu
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Carmen Ainola
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Noriko Sato
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Gabriella Abbate
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Emily S Wilson
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Mahé Bouquet
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Kieran Hyslop
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Margaret R Passmore
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Shinichi Ijuin
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan
| | - Sun Kyun Ro
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Thoracic and Cardiovascular Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Gabriele Fior
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Lucia Gandini
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Brooke Lundon
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - David G Platts
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Division of Cardiology, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Jacky Y Suen
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Gianluigi Li Bassi
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Intensive Care Unit, St. Andrews War Memorial Hospital, Brisbane, Queensland, Australia
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Intensive Care Unit, St. Andrews War Memorial Hospital, Brisbane, Queensland, Australia
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10
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Notomi Y. Coupling is about work: matched as chamber, not really as fibre. Eur Heart J Cardiovasc Imaging 2024; 25:782-783. [PMID: 38407312 DOI: 10.1093/ehjci/jeae056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 02/20/2024] [Indexed: 02/27/2024] Open
Affiliation(s)
- Yuichi Notomi
- Cardiovascular and Internal medicine, Haneda Chronogate Clinic, 11-1 Haneda-Asahicho, Ohta-ku, Tokyo 144-0042, Japan
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11
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Wang Q, Tang TM, Youlton N, Weldy CS, Kenney AM, Ronen O, Weston Hughes J, Chin ET, Sutton SC, Agarwal A, Li X, Behr M, Kumbier K, Moravec CS, Wilson Tang WH, Margulies KB, Cappola TP, Butte AJ, Arnaout R, Brown JB, Priest JR, Parikh VN, Yu B, Ashley EA. Epistasis regulates genetic control of cardiac hypertrophy. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2023.11.06.23297858. [PMID: 37987017 PMCID: PMC10659487 DOI: 10.1101/2023.11.06.23297858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
The combinatorial effect of genetic variants is often assumed to be additive. Although genetic variation can clearly interact non-additively, methods to uncover epistatic relationships remain in their infancy. We develop low-signal signed iterative random forests to elucidate the complex genetic architecture of cardiac hypertrophy. We derive deep learning-based estimates of left ventricular mass from the cardiac MRI scans of 29,661 individuals enrolled in the UK Biobank. We report epistatic genetic variation including variants close to CCDC141 , IGF1R , TTN , and TNKS. Several loci where variants were deemed insignificant in univariate genome-wide association analyses are identified. Functional genomic and integrative enrichment analyses reveal a complex gene regulatory network in which genes mapped from these loci share biological processes and myogenic regulatory factors. Through a network analysis of transcriptomic data from 313 explanted human hearts, we found strong gene co-expression correlations between these statistical epistasis contributors in healthy hearts and a significant connectivity decrease in failing hearts. We assess causality of epistatic effects via RNA silencing of gene-gene interactions in human induced pluripotent stem cell-derived cardiomyocytes. Finally, single-cell morphology analysis using a novel high-throughput microfluidic system shows that cardiomyocyte hypertrophy is non-additively modifiable by specific pairwise interactions between CCDC141 and both TTN and IGF1R . Our results expand the scope of genetic regulation of cardiac structure to epistasis.
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12
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Bronicki RA, Tume S, Gomez H, Dezfulian C, Penny DJ, Pinsky MR, Burkhoff D. Application of Cardiovascular Physiology to the Critically Ill Patient. Crit Care Med 2024; 52:821-832. [PMID: 38126845 DOI: 10.1097/ccm.0000000000006136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
OBJECTIVES To use the ventricular pressure-volume relationship and time-varying elastance model to provide a foundation for understanding cardiovascular physiology and pathophysiology, interpreting advanced hemodynamic monitoring, and for illustrating the physiologic basis and hemodynamic effects of therapeutic interventions. We will build on this foundation by using a cardiovascular simulator to illustrate the application of these principles in the care of patients with severe sepsis, cardiogenic shock, and acute mechanical circulatory support. DATA SOURCES Publications relevant to the discussion of the time-varying elastance model, cardiogenic shock, and sepsis were retrieved from MEDLINE. Supporting evidence was also retrieved from MEDLINE when indicated. STUDY SELECTION, DATA EXTRACTION, AND SYNTHESIS Data from relevant publications were reviewed and applied as indicated. CONCLUSIONS The ventricular pressure-volume relationship and time-varying elastance model provide a foundation for understanding cardiovascular physiology and pathophysiology. We have built on this foundation by using a cardiovascular simulator to illustrate the application of these important principles and have demonstrated how complex pathophysiologic abnormalities alter clinical parameters used by the clinician at the bedside.
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Affiliation(s)
- Ronald A Bronicki
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Sebastian Tume
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Hernando Gomez
- Critical Care Medicine Department, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Cameron Dezfulian
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Daniel J Penny
- Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Michael R Pinsky
- Critical Care Medicine Department, University of Pittsburgh School of Medicine, Pittsburgh, PA
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13
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Usui Y, Hanashima A, Hashimoto K, Kimoto M, Ohira M, Mohri S. Comparative analysis of ventricular stiffness across species. Physiol Rep 2024; 12:e16013. [PMID: 38644486 PMCID: PMC11033294 DOI: 10.14814/phy2.16013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 04/01/2024] [Accepted: 04/01/2024] [Indexed: 04/23/2024] Open
Abstract
Investigating ventricular diastolic properties is crucial for understanding the physiological cardiac functions in organisms and unraveling the pathological mechanisms of cardiovascular disorders. Ventricular stiffness, a fundamental parameter that defines ventricular diastolic functions in chordates, is typically analyzed using the end-diastolic pressure-volume relationship (EDPVR). However, comparing ventricular stiffness accurately across chambers of varying maximum volume capacities has been a long-standing challenge. As one of the solutions to this problem, we propose calculating a relative ventricular stiffness index by applying an exponential approximation formula to the EDPVR plot data of the relationship between ventricular pressure and values of normalized ventricular volume by the ventricular weight. This article reviews the potential, utility, and limitations of using normalized EDPVR analysis in recent studies. Herein, we measured and ranked ventricular stiffness in differently sized and shaped chambers using ex vivo ventricular pressure-volume analysis data from four animals: Wistar rats, red-eared slider turtles, masu salmon, and cherry salmon. Furthermore, we have discussed the mechanical effects of intracellular and extracellular viscoelastic components, Titin (Connectin) filaments, collagens, physiological sarcomere length, and other factors that govern ventricular stiffness. Our review provides insights into the comparison of ventricular stiffness in different-sized ventricles between heterologous and homologous species, including non-model organisms.
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Grants
- JP22K15155 Japan Society for the Promotion of Science, Grant/Award Number
- JP20K21453 Japan Society for the Promotion of Science, Grant/Award Number
- JP20H04508 Japan Society for the Promotion of Science, Grant/Award Number
- JP21K19933 Japan Society for the Promotion of Science, Grant/Award Number
- JP20H04521 Japan Society for the Promotion of Science, Grant/Award Number
- JP17H02092 Japan Society for the Promotion of Science, Grant/Award Number
- JP23H00556 Japan Society for the Promotion of Science, Grant/Award Number
- JP17H06272 Japan Society for the Promotion of Science, Grant/Award Number
- JP17H00859 Japan Society for the Promotion of Science, Grant/Award Number
- JP25560214 Japan Society for the Promotion of Science, Grant/Award Number
- JP16K01385 Japan Society for the Promotion of Science, Grant/Award Number
- JP26282127 Japan Society for the Promotion of Science, Grant/Award Number
- The Futaba research grant program
- Research Grant from the Kawasaki Foundation in 2016 from Medical Science and Medical Welfare
- Medical Research Grant in 2010 from Takeda Science Foundation
- R03S005 Research Project Grant from Kawasaki Medical School
- R03B050 Research Project Grant from Kawasaki Medical School
- R01B054 Research Project Grant from Kawasaki Medical School
- H30B041 Research Project Grant from Kawasaki Medical School
- H30B016 Research Project Grant from Kawasaki Medical School
- H27B10 Research Project Grant from Kawasaki Medical School
- R02B039 Research Project Grant from Kawasaki Medical School
- H28B80 Research Project Grant from Kawasaki Medical School
- R05B016 Research Project Grant from Kawasaki Medical School
- Japan Society for the Promotion of Science, Grant/Award Number
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Affiliation(s)
- Yuu Usui
- First Department of PhysiologyKawasaki Medical SchoolKurashikiOkayamaJapan
| | - Akira Hanashima
- First Department of PhysiologyKawasaki Medical SchoolKurashikiOkayamaJapan
| | - Ken Hashimoto
- First Department of PhysiologyKawasaki Medical SchoolKurashikiOkayamaJapan
| | - Misaki Kimoto
- First Department of PhysiologyKawasaki Medical SchoolKurashikiOkayamaJapan
| | - Momoko Ohira
- First Department of PhysiologyKawasaki Medical SchoolKurashikiOkayamaJapan
| | - Satoshi Mohri
- First Department of PhysiologyKawasaki Medical SchoolKurashikiOkayamaJapan
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14
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Dhont S, van den Acker G, van Loon T, Verbrugge FH, Verwerft J, Deferm S, Churchill TW, Mullens W, Lumens J, Bertrand PB. Mitral regurgitation in heart failure with preserved ejection fraction: The interplay of valve, ventricle, and atrium. Eur J Heart Fail 2024; 26:974-983. [PMID: 38629747 PMCID: PMC11184410 DOI: 10.1002/ejhf.3231] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/22/2024] [Accepted: 03/26/2024] [Indexed: 05/31/2024] Open
Abstract
Mitral regurgitation (MR) is highly prevalent among patients with heart failure and preserved ejection fraction (HFpEF). Despite this combination being closely associated with unfavourable outcomes, it remains relatively understudied. This is partly due to the inherent heterogeneity of patients with HFpEF. To address this gap, dissecting HFpEF into mechanism-based phenotypes may offer a promising avenue for advancing our comprehension of these complex intertwined conditions. This review employs the validated CircAdapt model to explore the haemodynamic implications of moderate to severe MR across a well-defined spectrum of myocardial disease, characterized by impaired relaxation and reduced myocardial compliance. Both heart failure and mitral valve disease share overlapping symptomatology, primarily attributed to elevated pulmonary pressures. The intricate mechanisms contributing to these elevated pressures are multifaceted, potentially influenced by diastolic dysfunction, left atrial myopathy, and MR. Accurate evaluation of the haemodynamic and clinical impact of MR necessitates a comprehensive approach, taking into account the characteristics of both the left atrium and left ventricle, as well as their intricate interactions, which may currently be underemphasized in diagnostic practice. This holistic assessment is imperative for enhancing our understanding and refining therapeutic strategies within this patient cohort.
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Affiliation(s)
- Sebastiaan Dhont
- Faculty of Medicine and Life Sciences, LCRC, Hasselt University, Diepenbeek, Belgium
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Department of Future Health, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Gitte van den Acker
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Tim van Loon
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Frederik H. Verbrugge
- Center for Cardiovascular Diseases, University Hospital Brussels, Jette, Belgium
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jan Verwerft
- Faculty of Medicine and Life Sciences, LCRC, Hasselt University, Diepenbeek, Belgium
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium
| | - Sébastien Deferm
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Department of Cardiology, Inselspital Bern, Bern, Switzerland
| | | | - Wilfried Mullens
- Faculty of Medicine and Life Sciences, LCRC, Hasselt University, Diepenbeek, Belgium
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Department of Future Health, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Joost Lumens
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Philippe B. Bertrand
- Faculty of Medicine and Life Sciences, LCRC, Hasselt University, Diepenbeek, Belgium
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Department of Future Health, Ziekenhuis Oost-Limburg, Genk, Belgium
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15
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Borrelli F, Lombardi R, Canciello G, Frisso G, Todde G, Esposito G, Losi MA. Mechano-energetic efficiency in patients with hypertrophic cardiomyopathy with and without sarcomeric mutations. J Cardiovasc Transl Res 2024; 17:458-466. [PMID: 37833437 DOI: 10.1007/s12265-023-10441-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/18/2023] [Indexed: 10/15/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) is mainly caused by sarcomeric mutations which may affect myocardial mechano-energetic efficiency (MEE). We investigated the effects of sarcomeric mutations on MEE. A non-invasive pressure/volume (P/V) analysis was performed. We included 49 genetically screened HCM patients. MEEi was calculated as the ratio between stroke volume and heart rate normalized by LV mass. Fifty-seven percent (57%) HCM patients carried a sarcomeric mutation. Patients with and without sarcomeric mutations had similar LV ejection fraction, heart rate, LV mass, and LV outflow gradient. Younger age at diagnosis, family history of HCM, and lower MEEi were associated with presence of sarcomeric mutation (p = 0.017; p = 0.001 and p = 0.0001, respectively). Lower MEEi in HCM with sarcomeric mutation is not related to significant differences on filling pressure as shown on P/V analysis. Sarcomeric mutations determine a reduction of the LV pump performance as estimated by MEEi in HCM. Lower MEEi may predict a positive genetic analysis.
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Affiliation(s)
- Felice Borrelli
- Department of Advanced Biomedical Sciences, University Federico II of Naples, Via S Pansini, 5, I-801313, Naples, Italy
| | - Raffaella Lombardi
- Department of Advanced Biomedical Sciences, University Federico II of Naples, Via S Pansini, 5, I-801313, Naples, Italy
| | - Grazia Canciello
- Department of Advanced Biomedical Sciences, University Federico II of Naples, Via S Pansini, 5, I-801313, Naples, Italy
| | - Giulia Frisso
- Department of Molecular Medicine and Medical Biotechnologies, University Federico II of Naples, Via S Pansini, 5, I-801313, Naples, Italy
| | - Gaetano Todde
- Department of Advanced Biomedical Sciences, University Federico II of Naples, Via S Pansini, 5, I-801313, Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University Federico II of Naples, Via S Pansini, 5, I-801313, Naples, Italy
| | - Maria-Angela Losi
- Department of Advanced Biomedical Sciences, University Federico II of Naples, Via S Pansini, 5, I-801313, Naples, Italy.
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16
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Kato S, Himeno Y, Amano A. Mathematical analysis of left ventricular elastance with respect to afterload change during ejection phase. PLoS Comput Biol 2024; 20:e1011974. [PMID: 38635493 PMCID: PMC11025827 DOI: 10.1371/journal.pcbi.1011974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 03/07/2024] [Indexed: 04/20/2024] Open
Abstract
Since the left ventricle (LV) has pressure (Plv) and volume (Vlv), we can define LV elastance from the ratio between Plv and Vlv, termed as "instantaneous elastance." On the other hand, end-systolic elastance (Emax) is known to be a good index of LV contractility, which is measured by the slope of several end-systolic Plv-Vlv points obtained by using different loads. The word Emax originates from the assumption that LV elastance increases during the ejection phase and attains its maximum at the end-systole. From this concept, we can define another elastance determined by the slope of isochronous Plv-Vlv points, that is Plv-Vlv points at a certain time after the ejection onset time by using different loads. We refer to this elastance as "load-dependent elastance." To reveal the relation between these two elastances, we used a hemodynamic model that included a detailed ventricular myocyte contraction model. From the simulation results, we found that the isochronous Plv-Vlv points lay in one line and that the line slope corresponding to the load-dependent elastance slightly decreased during the ejection phase, which is quite different from the instantaneous elastance. Subsequently, we analyzed the mechanism determining these elastances from the model equations. We found that instantaneous elastance is directly related to contraction force generated by the ventricular myocyte, but the load-dependent elastance is determined by two factors: one is the transient characteristics of the cardiac cell, i.e., the velocity-dependent force drops characteristics in instantaneous shortening. The other is the force-velocity relation of the cardiac cell. We also found that the linear isochronous pressure-volume relation is based on the approximately linear relation between the time derivative of the cellular contraction force and the cellular shortening velocity that results from the combined characteristics of LV and aortic compliances.
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Affiliation(s)
- Shiro Kato
- Department of Bioinformatics, Ritsumeikan University, Kusatsu, Shiga, Japan
| | - Yukiko Himeno
- Department of Bioinformatics, Ritsumeikan University, Kusatsu, Shiga, Japan
| | - Akira Amano
- Department of Bioinformatics, Ritsumeikan University, Kusatsu, Shiga, Japan
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17
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Caenen A, Bézy S, Pernot M, Nightingale KR, Vos HJ, Voigt JU, Segers P, D'hooge J. Ultrasound Shear Wave Elastography in Cardiology. JACC Cardiovasc Imaging 2024; 17:314-329. [PMID: 38448131 DOI: 10.1016/j.jcmg.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 11/14/2023] [Accepted: 12/07/2023] [Indexed: 03/08/2024]
Abstract
The advent of high-frame rate imaging in ultrasound allowed the development of shear wave elastography as a noninvasive alternative for myocardial stiffness assessment. It measures mechanical waves propagating along the cardiac wall with speeds that are related to stiffness. The use of cardiac shear wave elastography in clinical studies is increasing, but a proper understanding of the different factors that affect wave propagation is required to correctly interpret results because of the heart's thin-walled geometry and intricate material properties. The aims of this review are to give an overview of the general concepts in cardiac shear wave elastography and to discuss in depth the effects of age, hemodynamic loading, cardiac morphology, fiber architecture, contractility, viscoelasticity, and system-dependent factors on the measurements, with a focus on clinical application. It also describes how these factors should be considered during acquisition, analysis, and reporting to ensure an accurate, robust, and reproducible measurement of the shear wave.
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Affiliation(s)
- Annette Caenen
- Institute for Biomedical Engineering and Technology, Ghent University, Ghent, Belgium; Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Stéphanie Bézy
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Mathieu Pernot
- Physics for Medicine, INSERM, CNRS, ESPCI, PSL University, Paris, France
| | | | - Hendrik J Vos
- Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium.
| | - Patrick Segers
- Institute for Biomedical Engineering and Technology, Ghent University, Ghent, Belgium
| | - Jan D'hooge
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
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18
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Wood G, Madsen TL, Kim WY, Lyhne MD. Increasing Levels of Positive End-expiratory Pressure Cause Stepwise Biventricular Stroke Work Reduction in a Porcine Model. Anesthesiology 2024; 140:240-250. [PMID: 37905995 DOI: 10.1097/aln.0000000000004821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
BACKGROUND Positive end-expiratory pressure (PEEP) is commonly applied to avoid atelectasis and improve oxygenation in patients during general anesthesia but affects cardiac pressures, volumes, and loading conditions through cardiorespiratory interactions. PEEP may therefore alter stroke work, which is the area enclosed by the pressure-volume loop and corresponds to the external work performed by the ventricles to eject blood. The low-pressure right ventricle may be even more susceptible to PEEP than the left ventricle. The authors hypothesized that increasing levels of PEEP would reduce stroke work in both ventricles. METHODS This was a prospective, observational, experimental study. Six healthy female pigs of approximately 60 kg were used. PEEP was stepwise increased from 0 to 5, 7, 9, 11, 13, 15, 17, and 20 cm H2O to cover the clinical spectrum of PEEP. Simultaneous, biventricular invasive pressure-volume loops, invasive blood pressures, and ventilator data were recorded. RESULTS Increasing PEEP resulted in stepwise reductions in left (5,740 ± 973 vs. 2,303 ± 1,154 mmHg · ml; P < 0.001) and right (2,064 ± 769 vs. 468 ± 133 mmHg · ml; P < 0.001) ventricular stroke work. The relative stroke work reduction was similar between the two ventricles. Left ventricular ejection fraction, afterload, and coupling were preserved. On the contrary, PEEP increased right ventricular afterload and caused right ventriculo-arterial uncoupling (0.74 ± 0.30 vs. 0.19 ± 0.13; P = 0.01) with right ventricular ejection fraction reduction (64 ± 8% vs. 37 ± 7%, P < 0.001). CONCLUSIONS A stepwise increase in PEEP caused stepwise reduction in biventricular stroke work. However, there are important interventricular differences in response to increased PEEP levels. PEEP increased right ventricular afterload leading to uncoupling and right ventricular ejection fraction decline. These findings may support clinical decision-making to further optimize PEEP as a means to balance between improving lung ventilation and preserving right ventricular function. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Gregory Wood
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Tobias Lynge Madsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Won Yong Kim
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Mads Dam Lyhne
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
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19
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Protti I, van den Enden A, Van Mieghem NM, Meuwese CL, Meani P. Looking Back, Going Forward: Understanding Cardiac Pathophysiology from Pressure-Volume Loops. BIOLOGY 2024; 13:55. [PMID: 38275731 PMCID: PMC10813445 DOI: 10.3390/biology13010055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024]
Abstract
Knowing cardiac physiology is essential for health care professionals working in the cardiovascular field. Pressure-volume loops (PVLs) offer a unique understanding of the myocardial working and have become pivotal in complex pathophysiological scenarios, such as profound cardiogenic shock or when mechanical circulatory supports are implemented. This review provides a comprehensive summary of the left and right ventricle physiology, based on the PVL interpretation.
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Affiliation(s)
- Ilaria Protti
- Department of Intensive Care and Cardiology, Cardiovascular Institute, Thoraxcenter, Erasmus University Medical Center, 3012 Rotterdam, The Netherlands; (I.P.)
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
| | - Antoon van den Enden
- Department of Intensive Care and Cardiology, Cardiovascular Institute, Thoraxcenter, Erasmus University Medical Center, 3012 Rotterdam, The Netherlands; (I.P.)
| | - Nicolas M. Van Mieghem
- Department of Intensive Care and Cardiology, Cardiovascular Institute, Thoraxcenter, Erasmus University Medical Center, 3012 Rotterdam, The Netherlands; (I.P.)
| | - Christiaan L. Meuwese
- Department of Intensive Care and Cardiology, Cardiovascular Institute, Thoraxcenter, Erasmus University Medical Center, 3012 Rotterdam, The Netherlands; (I.P.)
| | - Paolo Meani
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, 6229 Maastricht, The Netherlands
- Faculty of Health, Medicine and Life Sciences, Maastricht University, 6211 Maastricht, The Netherlands
- Thoracic Research Center, Innovative Medical Forum, Collegium Medicum Nicolaus Copernicus University, 85-094 Bydgoszcz, Poland
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20
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Stonko DP, Rousseau MC, Price C, Benike A, Treffalls RN, Brunton NE, Rosen D, Morrison JJ. Technical and analytical approach to biventricular pressure-volume loops in swine including a completely endovascular, percutaneous closed-chest large animal model. JVS Vasc Sci 2024; 5:100190. [PMID: 38486870 PMCID: PMC10938295 DOI: 10.1016/j.jvssci.2024.100190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/29/2023] [Indexed: 03/17/2024] Open
Abstract
Pressure-volume (PV) loop analysis is a sophisticated invasive approach to quantifying load-dependent and independent measures of cardiac function. Biventricular (BV) PV loops allow left and right ventricular function to be quantified simultaneously and independently, which is important for conditions and certain physiologic states, such as ventricular decoupling or acute physiologic changes. BV PV loops can be performed in an entirely endovascular, percutaneous, and closed-chest setting. This technique is helpful in a survival animal model, as a percutaneous monitoring system during endovascular device experiments, or in cases where chest wall compliance is being tested or may be a confounder. In this article, we describe the end-to-end implementation of a completely endovascular, totally percutaneous, and closed-chest large animal model to obtain contemporaneous BV PV loops in 40 to 70 kg swine. We describe the associated surgical and technical challenges and our solutions to obtaining endovascular BV PV loops, closed-chest cardiac output, and stroke volume (including validation of the correction factor necessary for thermodilution), as well as how to perform endovascular inferior vena cava occlusion in this swine model. We also include techniques for data acquisition and analysis that are required for this method.
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Affiliation(s)
- David P. Stonko
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Mathieu C. Rousseau
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
- Division of Thoracic Surgery, Department of Surgery, University of Montreal, Montreal, QC, Canada
| | - Colin Price
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Amy Benike
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Rebecca N. Treffalls
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
- School of Medicine, University of the Incarnate Word, San Antonio, TX
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21
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Cicci L, Fresca S, Manzoni A, Quarteroni A. Efficient approximation of cardiac mechanics through reduced-order modeling with deep learning-based operator approximation. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2024; 40:e3783. [PMID: 37921217 DOI: 10.1002/cnm.3783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/14/2023] [Accepted: 09/22/2023] [Indexed: 11/04/2023]
Abstract
Reducing the computational time required by high-fidelity, full-order models (FOMs) for the solution of problems in cardiac mechanics is crucial to allow the translation of patient-specific simulations into clinical practice. Indeed, while FOMs, such as those based on the finite element method, provide valuable information on the cardiac mechanical function, accurate numerical results can be obtained at the price of very fine spatio-temporal discretizations. As a matter of fact, simulating even just a few heartbeats can require up to hours of wall time on high-performance computing architectures. In addition, cardiac models usually depend on a set of input parameters that are calibrated in order to explore multiple virtual scenarios. To compute reliable solutions at a greatly reduced computational cost, we rely on a reduced basis method empowered with a new deep learning-based operator approximation, which we refer to as Deep-HyROMnet technique. Our strategy combines a projection-based POD-Galerkin method with deep neural networks for the approximation of (reduced) nonlinear operators, overcoming the typical computational bottleneck associated with standard hyper-reduction techniques employed in reduced-order models (ROMs) for nonlinear parametrized systems. This method can provide extremely accurate approximations to parametrized cardiac mechanics problems, such as in the case of the complete cardiac cycle in a patient-specific left ventricle geometry. In this respect, a 3D model for tissue mechanics is coupled with a 0D model for external blood circulation; active force generation is provided through an adjustable parameter-dependent surrogate model as input to the tissue 3D model. The proposed strategy is shown to outperform classical projection-based ROMs, in terms of orders of magnitude of computational speed-up, and to return accurate pressure-volume loops in both physiological and pathological cases. Finally, an application to a forward uncertainty quantification analysis, unaffordable if relying on a FOM, is considered, involving output quantities of interest such as, for example, the ejection fraction or the maximal rate of change in pressure in the left ventricle.
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Affiliation(s)
- Ludovica Cicci
- MOX-Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
| | - Stefania Fresca
- MOX-Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
| | - Andrea Manzoni
- MOX-Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
| | - Alfio Quarteroni
- MOX-Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
- Mathematics Institute, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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22
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Seemann F, Heiberg E, Bruce CG, Khan JM, Potersnak A, Ramasawmy R, Carlsson M, Arheden H, Lederman RJ, Campbell-Washburn AE. Non-invasive pressure-volume loops using the elastance model and CMR: a porcine validation at transient pre-loads. EUROPEAN HEART JOURNAL. IMAGING METHODS AND PRACTICE 2024; 2:qyae016. [PMID: 38645798 PMCID: PMC11026081 DOI: 10.1093/ehjimp/qyae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/28/2024] [Indexed: 04/23/2024]
Abstract
Aims Pressure-volume (PV) loops have utility in the evaluation of cardiac pathophysiology but require invasive measurements. Recently, a time-varying elastance model to derive PV loops non-invasively was proposed, using left ventricular (LV) volume by cardiovascular magnetic resonance (CMR) and brachial cuff pressure as inputs. Validation was performed using CMR and pressure measurements acquired on the same day, but not simultaneously, and without varying pre-loads. This study validates the non-invasive elastance model used to estimate PV loops at varying pre-loads, compared with simultaneous measurements of invasive pressure and volume from real-time CMR, acquired concurrent to an inferior vena cava (IVC) occlusion. Methods and results We performed dynamic PV loop experiments under CMR guidance in 15 pigs (n = 7 naïve, n = 8 with ischaemic cardiomyopathy). Pre-load was altered by IVC occlusion, while simultaneously acquiring invasive LV pressures and volumes from real-time CMR. Pairing pressure and volume signals yielded invasive PV loops, and model-based PV loops were derived using real-time LV volumes. Haemodynamic parameters derived from invasive and model-based PV loops were compared. Across 15 pigs, 297 PV loops were recorded. Intra-class correlation coefficient (ICC) agreement was excellent between model-based and invasive parameters: stroke work (bias = 0.007 ± 0.03 J, ICC = 0.98), potential energy (bias = 0.02 ± 0.03 J, ICC = 0.99), ventricular energy efficiency (bias = -0.7 ± 2.7%, ICC = 0.98), contractility (bias = 0.04 ± 0.1 mmHg/mL, ICC = 0.97), and ventriculoarterial coupling (bias = 0.07 ± 0.15, ICC = 0.99). All haemodynamic parameters differed between naïve and cardiomyopathy animals (P < 0.05). The invasive vs. model-based PV loop dice similarity coefficient was 0.88 ± 0.04. Conclusion An elastance model-based estimation of PV loops and associated haemodynamic parameters provided accurate measurements at transient loading conditions compared with invasive PV loops.
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Affiliation(s)
- Felicia Seemann
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Building 10 Rm B1D219, Bethesda, MD 20892, USA
| | - Einar Heiberg
- Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund University, Entrégatan 7, 221 85 Lund, Sweden
| | - Christopher G Bruce
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Building 10 Rm B1D219, Bethesda, MD 20892, USA
| | - Jaffar M Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Building 10 Rm B1D219, Bethesda, MD 20892, USA
| | - Amanda Potersnak
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Building 10 Rm B1D219, Bethesda, MD 20892, USA
| | - Rajiv Ramasawmy
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Building 10 Rm B1D219, Bethesda, MD 20892, USA
| | - Marcus Carlsson
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Building 10 Rm B1D219, Bethesda, MD 20892, USA
| | - Håkan Arheden
- Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund University, Entrégatan 7, 221 85 Lund, Sweden
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Building 10 Rm B1D219, Bethesda, MD 20892, USA
| | - Adrienne E Campbell-Washburn
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Building 10 Rm B1D219, Bethesda, MD 20892, USA
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23
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Hudson ER, Weil BR. Porcine Model of Hypertrophy-Independent Left Ventricular Stiffening via Repetitive Pressure Overload. Methods Mol Biol 2024; 2803:205-217. [PMID: 38676895 DOI: 10.1007/978-1-0716-3846-0_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
Diastolic dysfunction arising from alterations in myocardial structure and/or function is a central component of several cardiovascular disorders, including heart failure with preserved ejection fraction (HFpEF). Basic research aimed at understanding underlying mechanisms contributing to the development of diastolic dysfunction has generally centered upon models of left ventricular (LV) hypertrophy arising from persistent and severe elevations in myocardial afterload (e.g., aortic banding). Mechanisms of hypertrophy-independent diastolic dysfunction, on the other hand, have received less attention, even though overt anatomic LV hypertrophy is absent in many HFpEF patients. Here, we describe the development of a novel porcine model of repetitive pressure overload (RPO) in which chronic, intermittent exposure to transient episodes of hypertension produces an increase in LV stiffness, interstitial fibrosis, cardiomyocyte hypertrophy, and capillary rarefaction without significant changes in LV mass. This model offers important insight into how diastolic dysfunction and HFpEF may develop in the absence of comorbidities, sustained hypertension, or LV hypertrophy, while also providing a useful translational research tool for investigation of novel therapeutic approaches to restore myocardial compliance and improve diastolic function.
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Affiliation(s)
| | - Brian R Weil
- The Department of Physiology & Biophysics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
- Clinical Translational Research Center, Buffalo, NY, USA.
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24
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Uwase E, Caru M, Curnier D, Abasq M, Andelfinger G, Krajinovic M, Laverdière C, Sinnett D, Périé D. Relationship between cardiac mechanical properties and cardiac magnetic resonance imaging at rest in childhood acute lymphoblastic leukemia survivors. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:2589-2598. [PMID: 37728802 DOI: 10.1007/s10554-023-02953-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/05/2023] [Indexed: 09/21/2023]
Abstract
The characterization of cardiac mechanical properties may contribute to better understanding of doxorubicin-induced cardiotoxicity. Our study aims to investigate the relationship between cardiac mechanical properties, T1 and T2 relaxation times and partition coefficient. Fifty childhood acute lymphoblastic leukemia survivors underwent a cardiac magnetic resonance (CMR) at rest on a 3T MRI system and included a standard ECG-gated 3(3)3(3)5 MOLLI sequence for T1 mapping and an ECG-gated T2-prepared TrueFISP sequence for T2 mapping. Partition coefficient, ejection fraction, end-diastolic volume (EDV) and end-systolic volume (ESV) were calculated. CircAdapt model was used to study cardiac mechanical performance (left ventricle stiffness (LVS), contractility (LVC) and pressure (Pmin and Pmax), cardiac work efficiency (CWE) and ventricular arterial coupling). In the whole cohort, our results showed that LVC (R2 = 69.2%, r = 0.83), Pmin (R2 = 62.9%, r = 0.79) and Pmax can be predicted by significant CMR parameters, while T1 (R2 = 23.2%, r = 0.48) and partition coefficient (R2 = 13.8%, r = 0.37) can be predicted by significant cardiac mechanical properties. In SR group LVS (R2 = 94.8%, r = 0.97), LVC (R2 = 93.7%, r = 0.96) and Pmin (R2 = 90.6%, r = 0.95) can be predicted by significant cardiac mechanical properties, while in HR + DEX group CWE (R2 = 49.8%, r = 0.70) can be predicted by significant cardiac mechanical properties. Partition coefficient (R2 = 72.6%, r = 0.85) can be predicted by significant CMR parameters in SR group. Early characterization of cardiac mechanical properties from CMR parameters has the potential to early detect doxorubicin-induced cardiotoxicity.
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Affiliation(s)
- Egidie Uwase
- Department of Mechanical Engineering, Polytechnique Montreal, P.O. Box 6079, Montreal, Québec, H3C 3A7, Canada
| | - Maxime Caru
- Department of Mechanical Engineering, Polytechnique Montreal, P.O. Box 6079, Montreal, Québec, H3C 3A7, Canada
- Research Center, Sainte-Justine University Health Center, Montreal, Canada
| | - Daniel Curnier
- Research Center, Sainte-Justine University Health Center, Montreal, Canada
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Maxence Abasq
- Department of Mechanical Engineering, Polytechnique Montreal, P.O. Box 6079, Montreal, Québec, H3C 3A7, Canada
| | - Gregor Andelfinger
- Research Center, Sainte-Justine University Health Center, Montreal, Canada
- Department of Pediatrics, University of Montreal, Montreal, Canada
| | - Maja Krajinovic
- Research Center, Sainte-Justine University Health Center, Montreal, Canada
- Department of Pediatrics, University of Montreal, Montreal, Canada
| | - Caroline Laverdière
- Research Center, Sainte-Justine University Health Center, Montreal, Canada
- Department of Pediatrics, University of Montreal, Montreal, Canada
| | - Daniel Sinnett
- Research Center, Sainte-Justine University Health Center, Montreal, Canada
- Department of Pediatrics, University of Montreal, Montreal, Canada
| | - Delphine Périé
- Department of Mechanical Engineering, Polytechnique Montreal, P.O. Box 6079, Montreal, Québec, H3C 3A7, Canada.
- Research Center, Sainte-Justine University Health Center, Montreal, Canada.
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25
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Orlitová M, Verbelen T, Frick AE, Vanstapel A, Van Beersel D, Ordies S, Van Slambrouck J, Kaes J, Jin X, Coudyzer W, Verleden SE, Verleden GM, Vanaudenaerde BM, Van Raemdonck DE, Vos R, Ceulemans LJ, Claus P, Neyrinck AP. The hemodynamic interplay between pulmonary ischemia-reperfusion injury and right ventricular function in lung transplantation: a translational porcine model. Am J Physiol Lung Cell Mol Physiol 2023; 325:L675-L688. [PMID: 37724349 DOI: 10.1152/ajplung.00281.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 09/06/2023] [Accepted: 09/13/2023] [Indexed: 09/20/2023] Open
Abstract
Lung transplantation (LTx) is a challenging procedure. Following the process of ischemia-reperfusion injury, the transplanted pulmonary graft might become severely damaged, resulting in primary graft dysfunction. In addition, during the intraoperative window, the right ventricle (RV) is at risk of acute failure. The interaction of right ventricular function with lung injury is, however, poorly understood. We aimed to address this interaction in a translational porcine model of pulmonary ischemia-reperfusion injury. Advanced pulmonary and hemodynamic assessment was used, including right ventricular pressure-volume loop analysis. The acute model was based on clamping and unclamping of the left lung hilus, respecting the different hemodynamic phases of a clinical lung transplantation. We found that forcing entire right ventricular cardiac output through a lung suffering from ischemia-reperfusion injury increased afterload (pulmonary vascular resistance from baseline to end experiment P < 0.0001) and induced right ventricular failure (RVF) in 5/9 animals. Notably, we identified different compensation patterns in failing versus nonfailing ventricles (arterial elastance P = 0.0008; stroke volume P < 0.0001). Furthermore, increased vascular pressure and flow produced by the right ventricle resulted in higher pulmonary injury, as measured by ex vivo CT density (correlation: pressure r = 0.8; flow r = 0.85). Finally, RV ischemia as measured by troponin-T was negatively correlated with pulmonary injury (r = -0.76); however, troponin-T values did not determine RVF in all animals. In conclusion, we demonstrate a delicate balance between development of pulmonary ischemia-reperfusion injury and right ventricular function during lung transplantation. Furthermore, we provide a physiological basis for potential benefit of extracorporeal life support technology.NEW & NOTEWORTHY In contrast to the abundant literature of mechanical pulmonary artery clamping to increase right ventricular afterload, we developed a model adding a biological factor of pulmonary ischemia-reperfusion injury. We did not only focus on the right ventricular behavior, but also on the interaction with the injured lung. We are the first to describe this interaction while addressing the hemodynamic intraoperative phases of clinical lung transplantation.
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Affiliation(s)
- Michaela Orlitová
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Tom Verbelen
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Anna E Frick
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Arno Vanstapel
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Dieter Van Beersel
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - Sofie Ordies
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - Jan Van Slambrouck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Janne Kaes
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Xin Jin
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Walter Coudyzer
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Stijn E Verleden
- Antwerp Surgical Training, Anatomy and Research Center, University of Antwerp, Antwerp, Belgium
| | - Geert M Verleden
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Bart M Vanaudenaerde
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Dirk E Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Robin Vos
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Laurens J Ceulemans
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Piet Claus
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Arne P Neyrinck
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
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26
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Stonko DP, Edwards J, Abdou H, Treffalls RN, Walker P, DeMartino RR, Mendes BC, Hicks CW, Morrison JJ. Thoracic Endovascular Aortic RepairAcutely Augments Left Ventricular Biomechanics in An Animal Model: A Mechanism for Postoperative Heart Failure and Hypertension. Ann Vasc Surg 2023; 97:18-26. [PMID: 37068623 PMCID: PMC10754260 DOI: 10.1016/j.avsg.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/27/2023] [Accepted: 04/05/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Thoracic aortic stent grafts are thought to decrease aortic compliance and may contribute to hypertension and heart failure after thoracic endovascular aortic repair (TEVAR). Left ventricular (LV) biomechanics immediately after TEVAR, however, have not been quantified. Pressure-volume (PV) loop analysis provides gold-standard LV functional information. The aim of this study is to use an LV PV loop catheter and analysis to characterize the LV biomechanics before and acutely after TEVAR. METHODS Anesthetized Yorkshire swine (N = 6) were percutaneously instrumented with an LV PV loop catheter. A 20 mm × 10 cm stent graft was deployed distal to the left subclavian via the femoral artery under fluoroscopy. Cardiac biomechanics were assessed before and after TEVAR. As a sensitivity analysis, inferior vena cava occlusion with PV loop assessment was performed pre and post-TEVAR in 1 animal to obtain preload and afterload-independent end-systolic and end-diastolic PV relationships (ESPVR and EDPVR). RESULTS All animals underwent successful instrumentation and TEVAR. Post-TEVAR, all 6 animals had higher mean LV ESP (106 vs. 118 mm Hg, P = 0.04), with no change in the EDPVR. inferior vena cava occlusion also moved the ESPVR curve upward and leftward, indicating increased LV work per unit time. There was no augmentation of EDPVR following TEVAR (P > 0.05). Postmortem exams in all animals revealed appropriate stent placement and no technical complications. CONCLUSIONS TEVAR was associated with an acute increase in LV end-systolic pressure and shift in the ESPVR, indicating increased ventricular work. This data provides potential mechanistic insights into the development of post-TEVAR hypertension and heart failure. Future stent graft innovation should focus on minimizing the changes in cardiac physiology.
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Affiliation(s)
- David P Stonko
- Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD; R. Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD
| | - Joseph Edwards
- R. Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD
| | - Hossam Abdou
- R. Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD
| | | | - Patrick Walker
- R. Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD
| | | | - Bernardo C Mendes
- Divison of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Caitlin W Hicks
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD
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27
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Garrett AS, Dowrick J, Taberner AJ, Han JC. Isolated cardiac muscle contracting against a real-time model of systemic and pulmonary cardiovascular loads. Am J Physiol Heart Circ Physiol 2023; 325:H1223-H1234. [PMID: 37712924 PMCID: PMC10907072 DOI: 10.1152/ajpheart.00272.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/01/2023] [Accepted: 09/08/2023] [Indexed: 09/16/2023]
Abstract
Isolated cardiac tissues allow a direct assessment of cardiac muscle function and enable precise control of experimental loading conditions. However, current experimental methods do not expose isolated tissues to the same contraction pattern and cardiovascular loads naturally experienced by the heart. In this study, we implement a computational model of systemic-pulmonary impedance that is solved in real time and imposed on contracting isolated rat muscle tissues. This systemic-pulmonary model represents the cardiovascular system as a lumped-parameter, closed-loop circuit. The tissues performed force-length work-loop contractions where the model output informed both the shortening and restretch phases of each work-loop. We compared the muscle mechanics and energetics associated with work-loops driven by the systemic-pulmonary model with that of a model-based loading method that only accounts for shortening. We obtained results that show simultaneous changes of afterload and preload or end-diastolic length of the muscle, as compared with the static, user-defined preload as in the conventional loading method. This feature allows assessment of muscle work output, heat output, and efficiency of contraction as functions of end-diastolic length. The results reveal the behavior of cardiac muscle as a pump source to achieve load-dependent work and efficiency outputs over a wider range of loads. This study offers potential applications of the model to investigate cardiac muscle response to hemodynamic coupling between systemic and pulmonary circulations in an in vitro setting.NEW & NOTEWORTHY We present the use of a "closed-loop" model of systemic and pulmonary circulations to apply, for the first time, real-time model-calculated preload and afterload to isolated cardiac muscle preparations. This method extends current experimental protocols where only afterload has been considered. The extension to include preload provides the opportunity to investigate ventricular muscle response to hemodynamic coupling and as a pump source across a wider range of cardiovascular loads.
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Affiliation(s)
- Amy S Garrett
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Jarrah Dowrick
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Andrew J Taberner
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
- Department of Engineering Science and Biomedical Engineering, The University of Auckland, Auckland, New Zealand
| | - June-Chiew Han
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
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Caenen A, Keijzer L, Bézy S, Duchenne J, Orlowska M, Van Der Steen AFW, De Jong N, Bosch JG, Voigt JU, D'hooge J, Vos HJ. Continuous shear wave measurements for dynamic cardiac stiffness evaluation in pigs. Sci Rep 2023; 13:17660. [PMID: 37848474 PMCID: PMC10582168 DOI: 10.1038/s41598-023-44588-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/10/2023] [Indexed: 10/19/2023] Open
Abstract
Ultrasound-based shear wave elastography is a promising technique to non-invasively assess the dynamic stiffness variations of the heart. The technique is based on tracking the propagation of acoustically induced shear waves in the myocardium of which the propagation speed is linked to tissue stiffness. This measurement is repeated multiple times across the cardiac cycle to assess the natural variations in wave propagation speed. The interpretation of these measurements remains however complex, as factors such as loading and contractility affect wave propagation. We therefore applied transthoracic shear wave elastography in 13 pigs to investigate the dependencies of wave speed on pressure-volume derived indices of loading, myocardial stiffness, and contractility, while altering loading and inducing myocardial ischemia/reperfusion injury. Our results show that diastolic wave speed correlates to a pressure-volume derived index of operational myocardial stiffness (R = 0.75, p < 0.001), suggesting that both loading and intrinsic properties can affect diastolic wave speed. Additionally, the wave speed ratio, i.e. the ratio of systolic and diastolic speed, correlates to a pressure-volume derived index of contractility, i.e. preload-recruitable stroke work (R = 0.67, p < 0.001). Measuring wave speed ratio might thus provide a non-invasive index of contractility during ischemia/reperfusion injury.
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Affiliation(s)
- Annette Caenen
- Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
- Cardiovascular Imaging and Dynamics Lab, KU Leuven, Leuven, Belgium.
- Institute for Biomedical Engineering and Technology, Ghent University, Ghent, Belgium.
| | - Lana Keijzer
- Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Stéphanie Bézy
- Cardiovascular Imaging and Dynamics Lab, KU Leuven, Leuven, Belgium
| | - Jürgen Duchenne
- Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands
| | - Marta Orlowska
- Cardiovascular Imaging and Dynamics Lab, KU Leuven, Leuven, Belgium
| | | | - Nico De Jong
- Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands
| | - Johan G Bosch
- Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | - Jan D'hooge
- Cardiovascular Imaging and Dynamics Lab, KU Leuven, Leuven, Belgium
| | - Hendrik J Vos
- Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands
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Kim SM, Randall EB, Jezek F, Beard DA, Chesler NC. Computational modeling of ventricular-ventricular interactions suggest a role in clinical conditions involving heart failure. Front Physiol 2023; 14:1231688. [PMID: 37745253 PMCID: PMC10512181 DOI: 10.3389/fphys.2023.1231688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/09/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction: The left (LV) and right (RV) ventricles are linked biologically, hemodynamically, and mechanically, a phenomenon known as ventricular interdependence. While LV function has long been known to impact RV function, the reverse is increasingly being realized to have clinical importance. Investigating ventricular interdependence clinically is challenging given the invasive measurements required, including biventricular catheterization, and confounding factors such as comorbidities, volume status, and other aspects of subject variability. Methods: Computational modeling allows investigation of mechanical and hemodynamic interactions in the absence of these confounding factors. Here, we use a threesegment biventricular heart model and simple circulatory system to investigate ventricular interdependence under conditions of systolic and diastolic dysfunction of the LV and RV in the presence of compensatory volume loading. We use the end-diastolic pressure-volume relationship, end-systolic pressure-volume relationship, Frank Starling curves, and cardiac power output as metrics. Results: The results demonstrate that LV systolic and diastolic dysfunction lead to RV compensation as indicated by increases in RV power. Additionally, RV systolic and diastolic dysfunction lead to impaired LV filling, interpretable as LV stiffening especially with volume loading to maintain systemic pressure. Discussion: These results suggest that a subset of patients with intact LV systolic function and diagnosed to have impaired LV diastolic function, categorized as heart failure with preserved ejection fraction (HFpEF), may in fact have primary RV failure. Application of this computational approach to clinical data sets, especially for HFpEF, may lead to improved diagnosis and treatment strategies and consequently improved outcomes.
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Affiliation(s)
- Salla M. Kim
- Department of Biomedical Engineering, Edwards Lifesciences Foundation Cardiovascular Innovation and Research Center, University of California Irvine, Irvine, CA, United States
| | - E. Benjamin Randall
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, United States
| | - Filip Jezek
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, United States
- Department of Pathological Physiology, First Faculty of Medicine, Charles University, Prague, Czechia
| | - Daniel A. Beard
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, United States
| | - Naomi C. Chesler
- Department of Biomedical Engineering, Edwards Lifesciences Foundation Cardiovascular Innovation and Research Center, University of California Irvine, Irvine, CA, United States
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Mobin FU, Renaldo AC, Carrasco Perez E, Jordan JE, Neff LP, Williams TK, Johnson MA, Rahbar E. Investigating the variability in pressure-volume relationships during hemorrhage and aortic occlusion. Front Cardiovasc Med 2023; 10:1171904. [PMID: 37680564 PMCID: PMC10482261 DOI: 10.3389/fcvm.2023.1171904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 08/01/2023] [Indexed: 09/09/2023] Open
Abstract
Introduction The pressure-volume (P-V) relationships of the left ventricle are the classical benchmark for studying cardiac mechanics and pumping function. Perturbations in the P-V relationship (or P-V loop) can be informative and guide the management of heart failure, hypovolemia, and aortic occlusion. Traditionally, P-V loop analyses have been limited to a single-beat P-V loop or an average of consecutive P-V loops (e.g., 10 cardiac cycles). While there are several algorithms to obtain single-beat estimations of the end-systolic and end-diastolic pressure-volume relations (i.e., ESPVR and EDPVR, respectively), there remains a need to better evaluate the variations in P-V relationships longitudinally over time. This is particularly important when studying acute and transient hemodynamic and cardiac events, such as active hemorrhage or aortic occlusion. In this study, we aim to investigate the variability in P-V relationships during hemorrhagic shock and aortic occlusion, by leveraging on a previously published porcine hemorrhage model. Methods Briefly, swine were instrumented with a P-V catheter in the left ventricle of the heart and underwent a 25% total blood volume hemorrhage over 30 min, followed by either Zone 1 complete aortic occlusion (i.e., REBOA), Zone 1 endovascular variable aortic control (EVAC), or no occlusion as a control, for 45 min. Preload-independent metrics of cardiac performance were obtained at predetermined time points by performing inferior vena cava occlusion during a ventilatory pause. Continuous P-V loop data and other hemodynamic flow and pressure measurements were collected in real-time using a multi-channel data acquisition system. Results We developed a custom algorithm to quantify the time-dependent variance in both load-dependent and independent cardiac parameters from each P-V loop. As expected, all pigs displayed a significant decrease in the end-systolic pressures and volumes (i.e., ESP, ESV) after hemorrhage. The variability in response to hemorrhage was consistent across all three groups. However, upon introduction of REBOA, we observed significantly high levels of variability in both load-dependent and independent cardiac metrics such as ESP, ESV, and the slope of ESPVR (Ees). For instance, pigs receiving REBOA experienced a 342% increase in ESP from hemorrhage, while pigs receiving EVAC experienced only a 188% increase. The level of variability within the EVAC group was consistently less than that of the REBOA group, which suggests that the EVAC group may be more supportive of maintaining healthier cardiac performance than complete occlusion with REBOA. Discussion In conclusion, we successfully developed a novel algorithm to reliably quantify the single-beat and longitudinal P-V relations during hemorrhage and aortic occlusion. As expected, hemorrhage resulted in smaller P-V loops, reflective of decreased preload and afterload conditions; however, the cardiac output and heart rate were preserved. The use of REBOA and EVAC for 44 min resulted in the restoration of baseline afterload and preload conditions, but often REBOA exceeded baseline pressure conditions to an alarming level. The level of variability in response to REBOA was significant and could be potentially associated to cardiac injury. By quantifying each P-V loop, we were able to capture the variability in all P-V loops, including those that were irregular in shape and believe that this can help us identify critical time points associated with declining cardiac performance during hemorrhage and REBOA use.
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Affiliation(s)
- Fahim Usshihab Mobin
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston Salem, NC, United States
- Virginia Tech, Wake Forest University School of Biomedical Engineering and Sciences, Blacksburg, VA, United States
- Advanced Computational Cardiovascular Lab for Trauma, Hemorrhagic Shock & Critical Care, Wake Forest University School of Medicine, Winston Salem, NC, United States
| | - Antonio C. Renaldo
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston Salem, NC, United States
- Virginia Tech, Wake Forest University School of Biomedical Engineering and Sciences, Blacksburg, VA, United States
- Advanced Computational Cardiovascular Lab for Trauma, Hemorrhagic Shock & Critical Care, Wake Forest University School of Medicine, Winston Salem, NC, United States
| | - Enrique Carrasco Perez
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston Salem, NC, United States
| | - James E. Jordan
- Advanced Computational Cardiovascular Lab for Trauma, Hemorrhagic Shock & Critical Care, Wake Forest University School of Medicine, Winston Salem, NC, United States
- Department of Cardiothoracic Surgery, Wake Forest University School of Medicine, Winston Salem, NC, United States
| | - Lucas P. Neff
- Advanced Computational Cardiovascular Lab for Trauma, Hemorrhagic Shock & Critical Care, Wake Forest University School of Medicine, Winston Salem, NC, United States
- Department of General Surgery, Section of Pediatric Surgery, Wake Forest University School of Medicine, Winston Salem, NC, United States
- Certus Critical Care™ Inc., Salt Lake City, UT, United States
| | - Timothy K. Williams
- Advanced Computational Cardiovascular Lab for Trauma, Hemorrhagic Shock & Critical Care, Wake Forest University School of Medicine, Winston Salem, NC, United States
- Certus Critical Care™ Inc., Salt Lake City, UT, United States
- Department of Vascular and Endovascular Surgery, Wake Forest University School of Medicine, Winston Salem, NC, United States
| | - M. Austin Johnson
- Certus Critical Care™ Inc., Salt Lake City, UT, United States
- Department of Surgery, Division of Emergency Medicine, The University of Utah, Salt Lake City, UT, United States
| | - Elaheh Rahbar
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston Salem, NC, United States
- Virginia Tech, Wake Forest University School of Biomedical Engineering and Sciences, Blacksburg, VA, United States
- Advanced Computational Cardiovascular Lab for Trauma, Hemorrhagic Shock & Critical Care, Wake Forest University School of Medicine, Winston Salem, NC, United States
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31
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Zhang Y, Kalhöfer-Köchling M, Bodenschatz E, Wang Y. Physical model of end-diastolic and end-systolic pressure-volume relationships of a heart. Front Physiol 2023; 14:1195502. [PMID: 37670768 PMCID: PMC10475591 DOI: 10.3389/fphys.2023.1195502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/31/2023] [Indexed: 09/07/2023] Open
Abstract
Left ventricular stiffness and contractility, characterized by the end-diastolic pressure-volume relationship (EDPVR) and the end-systolic pressure-volume relationship (ESPVR), are two important indicators of the performance of the human heart. Although much research has been conducted on EDPVR and ESPVR, no model with physically interpretable parameters combining both relationships has been presented, thereby impairing the understanding of cardiac physiology and pathology. Here, we present a model that evaluates both EDPVR and ESPVR with physical interpretations of the parameters in a unified framework. Our physics-based model fits the available experimental data and in silico results very well and outperforms existing models. With prescribed parameters, the new model is used to predict the pressure-volume relationships of the left ventricle. Our model provides a deeper understanding of cardiac mechanics and thus will have applications in cardiac research and clinical medicine.
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Affiliation(s)
- Yunxiao Zhang
- Laboratory for Fluid Physics, Pattern Formation and Biocomplexity, Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Moritz Kalhöfer-Köchling
- Laboratory for Fluid Physics, Pattern Formation and Biocomplexity, Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Eberhard Bodenschatz
- Laboratory for Fluid Physics, Pattern Formation and Biocomplexity, Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
- Institute for Dynamics of Complex Systems, University of Göttingen, Göttingen, Germany
- Laboratory of Atomic and Solid-State Physics and Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, United States
| | - Yong Wang
- Laboratory for Fluid Physics, Pattern Formation and Biocomplexity, Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
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32
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Ito S, Takahama H, Asakura M, Abe Y, Ajioka M, Anzai T, Arikawa T, Hayashi T, Higashino Y, Hiramitsu S, Iwahashi N, Izumi C, Kimura K, Kinugawa K, Kioka H, Lim YJ, Matsuoka K, Matsuoka S, Motoki H, Nakamura S, Nakayama T, Nomura A, Sasaoka T, Takiuchi S, Toyoda S, Ueda T, Watanabe T, Yamada A, Yamamoto M, Sozu T, Kitakaze M. Efficacy of azilsartan on left ventricular diastolic dysfunction compared with candesartan: J-TASTE randomized controlled trial. Sci Rep 2023; 13:12517. [PMID: 37532820 PMCID: PMC10397297 DOI: 10.1038/s41598-023-39779-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 07/31/2023] [Indexed: 08/04/2023] Open
Abstract
Characterized by ventricular and vascular stiffness, heart failure with preserved ejection fraction (HFpEF) has led to high morbidity and mortality. As azilsartan is an angiotensin receptor blocker with the highest myocardial and vascular affinities, azilsartan may improve the left ventricular (LV) diastolic function in patients with hypertension and either HFpEF or HF with mildly reduced ejection fraction (HFmrEF) more than candesartan. In this randomized, open-label trial, we randomly assigned 193 hypertensive patients with HF and LV ejection fraction ≥ 45% to 20 mg of azilsartan (n = 95) or 8 mg of candesartan (n = 98), once daily for 48 weeks. After the initiation of treatment, changes in the doses of the study drugs were permitted based on the patient's conditions, including blood pressure (median dose at 48 weeks: azilsartan 20.0 mg/day, candesartan 8.0 mg/day). The primary endpoint was the baseline-adjusted change in the ratio of peak early diastolic transmitral flow velocity (E) to early diastolic mitral annular velocity (e') (E/e'). Adjusted least-squares mean (LSM) change in E/e' was - 0.8 (95% confidence interval [CI] - 1.49 to - 0.04) in the azilsartan group and 0.2 (95% CI - 0.49 to 0.94) in the candesartan group, providing the LSM differences of - 1.0 (95% CI - 2.01 to 0.03, P = 0.057). The median change in left atrial volume index was - 2.7 mL/m2 with azilsartan vs 1.4 mL/m2 with candesartan (P = 0.091). The frequency of adverse events related to hypotension and hyperkalemia did not differ between the groups. The current study did not provide strong evidence that azilsartan improves LV diastolic dysfunction, and further confirmatory study is required.
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Affiliation(s)
- Shin Ito
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
- Department of Clinical Medicine and Development, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hiroyuki Takahama
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masanori Asakura
- Department of Clinical Medicine and Development, National Cerebral and Cardiovascular Center, Osaka, Japan
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yukio Abe
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Masayoshi Ajioka
- Department of Cardiovascular Internal Medicine, Tosei General Hospital, Seto, Aichi, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Takuo Arikawa
- Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Tochigi, Japan
| | | | - Yorihiko Higashino
- Department of Cardiology, Higashi Takarazuka Satoh Hospital, Takarazuka, Hyogo, Japan
| | | | - Noriaki Iwahashi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Koichiro Kinugawa
- The Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Hidetaka Kioka
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Young-Jae Lim
- Cardiovascular Center, Kawachi General Hospital, Osaka, Japan
| | - Ken Matsuoka
- Department of Internal Medicine, Yoshikawa Hospital, Osaka, Japan
| | | | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Sunao Nakamura
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Takafumi Nakayama
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Akihiro Nomura
- Innovative Clinical Research Center/Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | | | - Shin Takiuchi
- Department of Cardiology, Higashi Takarazuka Satoh Hospital, Takarazuka, Hyogo, Japan
| | - Shigeru Toyoda
- Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Tomoya Ueda
- Department of Cardiovascular Medicine, Nara Medical University, Nara, Japan
| | - Tetsuya Watanabe
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Akira Yamada
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Masayoshi Yamamoto
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Takashi Sozu
- Department of Information and Computer Technology, Faculty of Engineering, Tokyo University of Science, Tokyo, Japan
| | - Masafumi Kitakaze
- Department of Clinical Medicine and Development, National Cerebral and Cardiovascular Center, Osaka, Japan.
- Department of Cardiovascular Medicine, Hanwa Memorial Hospital, 3-5-8 Minamisumiyoshi, Sumiyoshi-ku, Osaka, 558-0041, Japan.
- The Osaka Medical Research Foundation for Intractable Diseases, Osaka, Japan.
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Dayer N, Ltaief Z, Liaudet L, Lechartier B, Aubert JD, Yerly P. Pressure Overload and Right Ventricular Failure: From Pathophysiology to Treatment. J Clin Med 2023; 12:4722. [PMID: 37510837 PMCID: PMC10380537 DOI: 10.3390/jcm12144722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/01/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
Right ventricular failure (RVF) is often caused by increased afterload and disrupted coupling between the right ventricle (RV) and the pulmonary arteries (PAs). After a phase of adaptive hypertrophy, pressure-overloaded RVs evolve towards maladaptive hypertrophy and finally ventricular dilatation, with reduced stroke volume and systemic congestion. In this article, we review the concept of RV-PA coupling, which depicts the interaction between RV contractility and afterload, as well as the invasive and non-invasive techniques for its assessment. The current principles of RVF management based on pathophysiology and underlying etiology are subsequently discussed. Treatment strategies remain a challenge and range from fluid management and afterload reduction in moderate RVF to vasopressor therapy, inotropic support and, occasionally, mechanical circulatory support in severe RVF.
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Affiliation(s)
- Nicolas Dayer
- Department of Cardiology, Lausanne University Hospital and Lausanne University, 1011 Lausanne, Switzerland;
| | - Zied Ltaief
- Department of Adult Intensive Care Medicine, Lausanne University Hospital and Lausanne University, 1011 Lausanne, Switzerland; (Z.L.); (L.L.)
| | - Lucas Liaudet
- Department of Adult Intensive Care Medicine, Lausanne University Hospital and Lausanne University, 1011 Lausanne, Switzerland; (Z.L.); (L.L.)
| | - Benoit Lechartier
- Department of Respiratory Medicine, Lausanne University Hospital and Lausanne University, 1011 Lausanne, Switzerland; (B.L.); (J.-D.A.)
| | - John-David Aubert
- Department of Respiratory Medicine, Lausanne University Hospital and Lausanne University, 1011 Lausanne, Switzerland; (B.L.); (J.-D.A.)
| | - Patrick Yerly
- Department of Cardiology, Lausanne University Hospital and Lausanne University, 1011 Lausanne, Switzerland;
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34
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Uwase E, Caru M, Curnier D, Abasq Meng M, Andelfinger G, Krajinovic M, Laverdière C, Sinnett D, Périé D. Cardiac Mechanical Performance Assessment at Different Levels of Exercise in Childhood Acute Lymphoblastic Leukemia Survivors. J Pediatr Hematol Oncol 2023; 45:247-255. [PMID: 37278566 DOI: 10.1097/mph.0000000000002682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 03/31/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND There is a shortage of relevant studies interested in cardiac mechanical performance. Thus, it is clinically relevant to study the impact of cancer treatments on survivors' cardiac mechanical performance to improve our knowledge. The first objective of this study is to assess survivors' cardiac mechanical performance during a cardiopulmonary exercise test (CPET) using both ventricular-arterial coupling (VAC) and cardiac work efficiency (CWE) from cardiac magnetic resonance (CMR) acquisitions. The second objective is to assess the impact of doxorubicin and dexrazoxane (DEX) treatments. METHODS A total of 63 childhood acute lymphoblastic leukemia survivors underwent a CMR at rest on a 3T magnetic resonance imaging system, followed by a CPET on ergocycle. The CircAdapt model was used to study cardiac mechanical performance. At different levels of exercise, arterial elastance, end-systolic elastance, VAC, and CWE were estimated. RESULTS We observed significant differences between the different levels of exercise for both VAC ( P <0.0001) and CWE parameters ( P =0.001). No significant differences were reported between prognostic risk groups at rest and during the CPET. Nevertheless, we observed that survivors in the SR group had a VAC value slightly lower than heart rate (HR)+DEX and HR groups throughout the CPET. Moreover, survivors in the SR group had a CWE parameter slightly higher than HR+DEX and HR groups throughout the CPET. CONCLUSIONS This study reveals that the combination of CPET, CMR acquisitions and CircAdapt model was sensitive enough to observe slight changes in the assessment of VAC and CWE parameters. Our study contributes to improving survivors' follow-up and detection of cardiac problems induced by doxorubicin-related cardiotoxicity.
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Affiliation(s)
- Egidie Uwase
- Department of Mechanical Engineering, Polytechnique
| | - Maxime Caru
- Department of Mechanical Engineering, Polytechnique
- Sainte-Justine University Health Center, Research Center
| | - Daniel Curnier
- Sainte-Justine University Health Center, Research Center
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | | | - Gregor Andelfinger
- Sainte-Justine University Health Center, Research Center
- Department of Pediatrics, University of Montreal
| | - Maja Krajinovic
- Sainte-Justine University Health Center, Research Center
- Department of Pediatrics, University of Montreal
| | - Caroline Laverdière
- Sainte-Justine University Health Center, Research Center
- Department of Pediatrics, University of Montreal
| | - Daniel Sinnett
- Sainte-Justine University Health Center, Research Center
- Department of Pediatrics, University of Montreal
| | - Delphine Périé
- Department of Mechanical Engineering, Polytechnique
- Sainte-Justine University Health Center, Research Center
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35
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Cioffi G, Battiston R, Mancusi C, Di Lenarda A, Faganello G, Aurigemma GP, Tarantini L, Pulignano G, Cioffi V, de Simone G. Prognostic Stratification of Clinically Stable Patients with Heart Failure by Echocardiographic Pressure/Volume Loop Model. J Am Soc Echocardiogr 2023; 36:746-759. [PMID: 36791831 DOI: 10.1016/j.echo.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 01/08/2023] [Accepted: 02/05/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Pressure/volume (P/V) loops provide useful information on left ventricular performance and prognosis in patients with heart failure (HF) but do not lend themselves to routine clinical practice. The authors developed a noninvasive method to compute individualized P/V loops to predict adverse clinical outcomes in patients with stable HF, which the authors believe can be used clinically. METHODS A derivation cohort (n = 443 patients) was used to develop an echocardiography P/V loop model, using brachial arterial pressure and trans-thoracic two-dimensional Doppler echocardiographic data. Each patient's P/V loop was depicted as an irregular pentagon, and a centroid was derived for each loop. The centroid distance (CD) from a reference centroid (derived from 101 healthy control subjects) was computed. This model was prospectively applied to 435 patients who constituted the validation cohort. The study end point was a composite of cardiac death or hospitalization for HF among study patients. RESULTS In the derivation cohort, CD was threefold greater among patients who experienced adverse events than those who did not. During a follow-up period of 30 months (15-45 months), event rates were 35% (72 of 206 patients) and 12% (29 of 237 patients P < .001), respectively, among patients with CD > 33 mL/mm Hg and those with CD ≤33 mL/mm Hg (prognostic cutoff derived by receiver operating characteristic analysis). Multivariate Cox analysis identified CD as an independent predictor of adverse outcome (hazard ratio, 1.61; 95% CI, 1.03-2.50) independently of left ventricular end-diastolic volume, pulmonary capillary wedge pressure, and left ventricular ejection fraction. These conclusions were confirmed in the validation cohort. CONCLUSIONS The authors propose a method to create a noninvasive P/V loop and its centroid. These data provide useful pathophysiologic and prognostic information in patients with HF.
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Affiliation(s)
- Giovanni Cioffi
- Cardiac Rehabilitation Centre, San Pancrazio Hospital, Trento, Italy; Rheumatology Section, Department of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
| | - Roberto Battiston
- Department of Experimental Physics, University of Trento, Trento, Italy
| | - Costantino Mancusi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | | | | | - Gerard P Aurigemma
- Division of Cardiovascular Medicine, Department of Medicine, UMass Chan Medical School, Worcester, Massachusetts
| | | | - Giovanni Pulignano
- Department of Cardiology, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Viola Cioffi
- Department of Experimental Physics, University of Trento, Trento, Italy
| | - Giovanni de Simone
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
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Kataoka Y, Fukuda Y, Shelly I, Peterson J, Yokota S, Uemura K, Saku K, Alexander J, Sunagawa K. Inverse ESPVR Estimation with Singularity Avoidance via Constrained EDPVR Parameter Optimization. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-6. [PMID: 38083332 DOI: 10.1109/embc40787.2023.10340472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Left ventricular end-systolic elastance Ees, as an index of cardiac contractility, can play a key role in continuous patient monitoring during cardiac treatment scenarios such as drug therapies. The clinical feasibility of Ees estimation remains challenging because most techniques have been built on left ventricular pressure and volume, which are difficult to measure or estimate in the regular ICU/CCU setting. The purpose of this paper is to propose and validate a novel approach to estimate Ees, which is independent of left ventricular pressure and volume. Our methods first derive an analytical representation of Ees as the inverse function of the gradient of the Frank-Starling Curve based on cardiac mechanics. Second, elucidating the mechanism of singularities in the inverse function, we derive multiple conditions in both end-systolic pressure-volume relationship (ESPVR) and end-diastolic pressure-volume relationship (EDPVR) parameters to avoid these singularities analytically. Third, we formulate a constrained nonlinear least squares problem to optimize both ESPVR and EDPVR parameters simultaneously to avoid singularities. The effectiveness of the proposed method in avoiding singularities was evaluated in an animal experiment. Compared to the conventional Ees estimation by linear regression, our proposed method reproduced in-vivo hemodynamics more accurately when simulating the estimated Ees variation during drug administration. Our method can be applied using the available data in the regular ICU/CCU setting. The improved clinical feasibility can support not only physicians' decision-making, including adjusting drug dosages in current clinical treatment, but also a closed-loop hemodynamic control system requiring accurate continuous Ees estimation.
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Yamazaki Y, Matsuki Y, Shigemi K. A method for calculating left ventricular ejection fraction noninvasively from left ventricular arterial coupling (Ees/Ea). BMC Anesthesiol 2023; 23:200. [PMID: 37308833 DOI: 10.1186/s12871-023-02159-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 05/30/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Ejection fraction (EF), which is assessed using ultrasonography, is a standard parameter for evaluating cardiac function in clinical cardiology and for cardiovascular management during general anesthesia. However, it is impossible to continuously and non-invasively assess EF using ultrasonography. The aim of our study was to develop a method for estimating EF non-invasively using the left ventricular arterial coupling ratio (Ees/Ea). METHODS Ees/Ea was estimated non-invasively using the parameters pre-ejection period (PEP), ejection time (ET), end-systolic pressure (Pes) and diastolic pressure (Pad), which were calculated from a vascular screening system, VeSera 1000/1500 (Fukuda Denshi Co., Ltd., Tokyo, Japan). Then, left ventricular efficiency (Eff) as a pump, defined as the ratio of external work (EW) to myocardial oxygen consumption, which strongly correlates with the pressure-volume area (PVA), was calculated by a new formula using Ees/Ea, and was used to approximate EF (EFeff). Simultaneously, we measured EF using transthoracic echocardiography (EFecho), and compared it with EFeff. RESULTS The study included 44 healthy adults (36 males, 8 females), in whom mean EFecho was 66 ± 5% and EFeff was 57 ± 9%. We found a positive correlation between EFecho and EFeff (R2 = 0.219, p < 0.05) on Bland-Altman analysis, with limits of agreement of - 7.5 to 24.4%, and percentage error of 24%. CONCLUSION The results suggest that EF can be measured non-invasively using left ventricular arterial coupling.
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Affiliation(s)
- Yukiko Yamazaki
- Intensive Care Medicine, University of Fukui Hospital, Fukui, Japan
| | - Yuka Matsuki
- Department of Anesthesiology and Reanimatology, Faculty of Medicine Sciences, University of Fukui Hospital, 23-3 Eiheijicho, Yoshidagun, 910-1193, Fukui, Japan.
| | - Kenji Shigemi
- Department of Anesthesiology and Reanimatology, Faculty of Medicine Sciences, University of Fukui Hospital, 23-3 Eiheijicho, Yoshidagun, 910-1193, Fukui, Japan
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Stiermaier T, Reil JC, Sequeira V, Rawish E, Mezger M, Pätz T, Paitazoglou C, Schmidt T, Frerker C, Steendijk P, Reil GH, Eitel I. Hemodynamic Assessment in Takotsubo Syndrome. J Am Coll Cardiol 2023; 81:1979-1991. [PMID: 37197841 DOI: 10.1016/j.jacc.2023.03.398] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/23/2023] [Accepted: 03/10/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Takotsubo syndrome (TTS) is a reversible form of heart failure with incompletely understood pathophysiology. OBJECTIVES This study analyzed altered cardiac hemodynamics during TTS to elucidate underlying disease mechanisms. METHODS Left ventricular (LV) pressure-volume loops were recorded in 24 consecutive patients with TTS and a control population of 20 participants without cardiovascular diseases. RESULTS TTS was associated with impaired LV contractility (end-systolic elastance 1.74 mm Hg/mL vs 2.35 mm Hg/mL [P = 0.024]; maximal rate of change in systolic pressure over time 1,533 mm Hg/s vs 1,763 mm Hg/s [P = 0.031]; end-systolic volume at a pressure of 150 mm Hg, 77.3 mL vs 46.4 mL [P = 0.002]); and a shortened systolic period (286 ms vs 343 ms [P < 0.001]). In response, the pressure-volume diagram was shifted rightward with significantly increased LV end-diastolic (P = 0.031) and end-systolic (P < 0.001) volumes, which preserved LV stroke volume (P = 0.370) despite a lower LV ejection fraction (P < 0.001). Diastolic function was characterized by prolonged active relaxation (relaxation constant 69.5 ms vs 45.9 ms [P < 0.001]; minimal rate of change in diastolic pressure -1,457 mm Hg/s vs -2,192 mm Hg/s [P < 0.001]), whereas diastolic stiffness (1/compliance) was not affected during TTS (end-diastolic volume at a pressure of 15 mm Hg, 96.7 mL vs 109.0 mL [P = 0.942]). Mechanical efficiency was significantly reduced in TTS (P < 0.001) considering reduced stroke work (P = 0.001), increased potential energy (P = 0.036), and a similar total pressure-volume area compared with that of control subjects (P = 0.357). CONCLUSIONS TTS is characterized by reduced cardiac contractility, a shortened systolic period, inefficient energetics, and prolonged active relaxation but unaltered diastolic passive stiffness. These findings may suggest decreased phosphorylation of myofilament proteins, which represents a potential therapeutic target in TTS. (Optimized Characterization of Takotsubo Syndrome by Obtaining Pressure Volume Loops [OCTOPUS]; NCT03726528).
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Affiliation(s)
- Thomas Stiermaier
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg-Kiel-Lübeck, Lübeck, Germany.
| | - Jan-Christian Reil
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany; Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany.
| | - Vasco Sequeira
- Comprehensive Heart Failure Center (CHFC), University Clinic Würzburg, Würzburg, Germany
| | - Elias Rawish
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg-Kiel-Lübeck, Lübeck, Germany
| | - Matthias Mezger
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Toni Pätz
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | | | - Tobias Schmidt
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | | | - Paul Steendijk
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Gert-Hinrich Reil
- Department of Cardiology, University Hospital Oldenburg, Oldenburg, Germany
| | - Ingo Eitel
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg-Kiel-Lübeck, Lübeck, Germany
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Coronel-Meneses D, Sánchez-Trasviña C, Ratera I, Mayolo-Deloisa K. Strategies for surface coatings of implantable cardiac medical devices. Front Bioeng Biotechnol 2023; 11:1173260. [PMID: 37256118 PMCID: PMC10225971 DOI: 10.3389/fbioe.2023.1173260] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/25/2023] [Indexed: 06/01/2023] Open
Abstract
Cardiac medical devices (CMDs) are required when the patient's cardiac capacity or activity is compromised. To guarantee its correct functionality, the building materials in the development of CMDs must focus on several fundamental properties such as strength, stiffness, rigidity, corrosion resistance, etc. The challenge is more significant because CMDs are generally built with at least one metallic and one polymeric part. However, not only the properties of the materials need to be taken into consideration. The biocompatibility of the materials represents one of the major causes of the success of CMDs in the short and long term. Otherwise, the material will lead to several problems of hemocompatibility (e.g., protein adsorption, platelet aggregation, thrombus formation, bacterial infection, and finally, the rejection of the CMDs). To enhance the hemocompatibility of selected materials, surface modification represents a suitable solution. The surface modification involves the attachment of chemical compounds or bioactive compounds to the surface of the material. These coatings interact with the blood and avoid hemocompatibility and infection issues. This work reviews two main topics: 1) the materials employed in developing CMDs and their key characteristics, and 2) the surface modifications reported in the literature, clinical trials, and those that have reached the market. With the aim of providing to the research community, considerations regarding the choice of materials for CMDs, together with the advantages and disadvantages of the surface modifications and the limitations of the studies performed.
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Affiliation(s)
- David Coronel-Meneses
- Tecnologico de Monterrey, The Institute for Obesity Research, Monterrey, Mexico
- Tecnologico de Monterrey, Escuela de Ingeniería y Ciencias, Centro de Biotecnología-FEMSA, Monterrey, Mexico
| | - Calef Sánchez-Trasviña
- Tecnologico de Monterrey, The Institute for Obesity Research, Monterrey, Mexico
- Tecnologico de Monterrey, Escuela de Ingeniería y Ciencias, Centro de Biotecnología-FEMSA, Monterrey, Mexico
| | - Imma Ratera
- Institute of Materials Science of Barcelona (ICMAB-CSIC), Campus UAB, Bellaterra, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Instituto de Salud Carlos IIIBellaterra, Spain
| | - Karla Mayolo-Deloisa
- Tecnologico de Monterrey, The Institute for Obesity Research, Monterrey, Mexico
- Tecnologico de Monterrey, Escuela de Ingeniería y Ciencias, Centro de Biotecnología-FEMSA, Monterrey, Mexico
- Institute of Materials Science of Barcelona (ICMAB-CSIC), Campus UAB, Bellaterra, Spain
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Kirk ME, Merit VT, Moeslund N, Dragsbaek SJ, Hansen JV, Andersen A, Lyhne MD. Impact of sternotomy and pericardiotomy on cardiopulmonary haemodynamics in a large animal model. Exp Physiol 2023; 108:762-771. [PMID: 36892095 PMCID: PMC10988510 DOI: 10.1113/ep090919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/14/2023] [Indexed: 03/10/2023]
Abstract
NEW FINDINGS What is the central question of this study? Invasive cardiovascular instrumentation can occur through closed- or open-chest approaches. To what extent will sternotomy and pericardiotomy affect cardiopulmonary variables? What is the main finding and its importance? Opening of the thorax decreased mean systemic and pulmonary pressures. Left ventricular function improved, but no changes were observed in right ventricular systolic measures. No consensus or recommendation exists regarding instrumentation. Methodological differences risk compromising rigour and reproducibility in preclinical research. ABSTRACT Animal models of cardiovascular disease are often evaluated by invasive instrumentation for phenotyping. As no consensus exists, both open- and closed-chest approaches are used, which might compromise rigour and reproducibility in preclinical research. We aimed to quantify the cardiopulmonary changes induced by sternotomy and pericardiotomy in a large animal model. Seven pigs were anaesthetized, mechanically ventilated and evaluated by right heart catheterization and bi-ventricular pressure-volume loop recordings at baseline and after sternotomy and pericardiotomy. Data were compared by ANOVA or the Friedmann test where appropriate, with post-hoc analyses to control for multiple comparisons. Sternotomy and pericardiotomy caused reductions in mean systemic (-12 ± 11 mmHg, P = 0.027) and pulmonary pressures (-4 ± 3 mmHg, P = 0.006) and airway pressures. Cardiac output decreased non-significantly (-1329 ± 1762 ml/min, P = 0.052). Left ventricular afterload decreased, with an increase in ejection fraction (+9 ± 7%, P = 0.027) and coupling. No changes were observed in right ventricular systolic function or arterial blood gases. In conclusion, open- versus closed-chest approaches to invasive cardiovascular phenotyping cause a systematic difference in key haemodynamic variables. Researchers should adopt the most appropriate approach to ensure rigour and reproducibility in preclinical cardiovascular research.
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Affiliation(s)
- Mathilde Emilie Kirk
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Department of CardiologyAarhus University HospitalAarhusDenmark
| | - Victor Tang Merit
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Department of CardiologyAarhus University HospitalAarhusDenmark
| | - Niels Moeslund
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Department of Cardiac, Lung and Vascular SurgeryAarhus University HospitalAarhusDenmark
| | - Simone Juel Dragsbaek
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Department of CardiologyAarhus University HospitalAarhusDenmark
| | - Jacob Valentin Hansen
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Department of CardiologyAarhus University HospitalAarhusDenmark
| | - Asger Andersen
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Department of CardiologyAarhus University HospitalAarhusDenmark
| | - Mads Dam Lyhne
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Department of Anaesthesiology and Intensive CareAarhus University HospitalAarhusDenmark
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Fontana M, Ioannou A, Bandera F. Non-invasive left ventricle pressure-volume loops: a new tool to track treatment response in cardiac transthyretin amyloidosis? Eur J Heart Fail 2023; 25:737-739. [PMID: 36987912 DOI: 10.1002/ejhf.2841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/27/2023] [Indexed: 03/30/2023] Open
Affiliation(s)
- Marianna Fontana
- National Amyloidosis Centre, University College London, London, UK
| | - Adam Ioannou
- National Amyloidosis Centre, University College London, London, UK
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Hiremath G, Batlivala S, Callahan R, Thatte N, Rockefeller T, Nawaytou H, Reddy SV, Hussain T, Chabiniok R, Butts R, Vettukattil J, Aregullin EO, Aldweib N, Burkhoff D, Brener MI. Clinical Applications of Pressure-Volume Assessment in Congenital Heart Disease. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:100599. [PMID: 39130717 PMCID: PMC11307813 DOI: 10.1016/j.jscai.2023.100599] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/02/2023] [Accepted: 01/31/2023] [Indexed: 08/13/2024]
Abstract
Ventricular pressure-volume (PV) loops offer unique insights into cardiovascular mechanics. PV loops can be instrumental in improving our understanding of various congenital heart diseases, including single ventricular physiology, heart failure, and pulmonary hypertension, as well as guiding therapeutic interventions. This review focuses on the theoretical and practical foundations for the acquisition and interpretation of PV loops in congenital heart disease and discusses their clinical applications.
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Affiliation(s)
- Gurumurthy Hiremath
- Division of Pediatric Cardiology, Department of Pediatrics, Masonic Children’s Hospital, University of Minnesota, Minneapolis, Minnesota
| | - Sarosh Batlivala
- Division of Pediatric Cardiology, The Heart Institute, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Ryan Callahan
- Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nikhil Thatte
- Department of Cardiology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Toby Rockefeller
- Interventional Pediatric Cardiology, University of Missouri-Kansas City School of Medicine, Children’s Mercy, Kansas City, Missouri
| | - Hythem Nawaytou
- Department of Pediatrics, UCSF Benioff Children’s Hospital and the University of California, San Francisco, California
| | | | - Tarique Hussain
- Pediatric Cardiology, Children’s Medical Center, Dallas, Texas
| | | | - Ryan Butts
- Pediatric Cardiology, Children’s Medical Center, Dallas, Texas
| | - Joseph Vettukattil
- Congenital Heart Center, Spectrum Health Helen DeVos Children’s Hospital, Grand Rapids, Michigan
| | - E. Oliver Aregullin
- Congenital Heart Center, Spectrum Health Helen DeVos Children’s Hospital, Grand Rapids, Michigan
| | - Nael Aldweib
- Division of Cardiovascular Medicine, Oregon Health Sciences University, Portland, Oregon
| | - Daniel Burkhoff
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York
| | - Michael I. Brener
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York
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Shin WJ, Kwon HM, Kim SH, Jang HY, Park YS, Kim JH, Kim KS, Moon YJ, Jun IG, Song JG, Hwang GS. Left ventricular remodeling in end-stage liver disease and post-transplant mortality assessed using end-diastolic pressure-volume relation analysis: Observational retrospective study. Am Heart J 2023; 262:10-19. [PMID: 37044363 DOI: 10.1016/j.ahj.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Diastolic dysfunction is regarded as an important predictor of outcome after liver transplantation (LT). We investigated the influence of liver disease severity on left ventricular diastolic properties using end-diastolic pressure-volume relationship (EDPVR) analysis in patients with end-stage liver disease (ESLD). Association between alterations of the EDPVR and mortality after LT was evaluated. METHODS In this observational retrospective cohort study, 3,211 patients who underwent LT for ESLD were included in analysis. Variables derived from single-beat EDPVR (diastolic stiffness-coefficient [β] and end-diastolic volume at an end-diastolic pressure of 20 mmHg [EDVI20] indicating ventricular capacitance) were estimated using preoperative echocardiographic data. Alterations in EDPVR with increased stiffness (β > 6.16) were categorized into 3 groups; leftward-shifted (EDVI20 <51 mL/m2), rightward-shifted (EDVI20 > 69.7 mL/m2), and intermediate (EDVI20 51-69.7 mL/m2). RESULTS As the model for ESLD score increases, both EDVI20 and β gradually increased, which indicated ventricular remodeling with larger capacitance and higher diastolic stiffness. Among patients with increased stiffness (β > 6.16, n = 1,090), survival rates after LT were lower in leftward-shifted EDPVR than in rightward-shifted EDPVR (73.7% vs 82.9%; log-rank P = 0.002). In the adjusted Cox proportional hazard model, risk of cumulative all-cause mortality at 11 years was the highest in leftward-shifted EDPVR (hazard ratio [HR]: 1.93; 95% confidence interval [CI]: 1.27-2.92), followed by intermediate EDPVR (HR: 1.55; 95% CI: 1.12-2.26), compared with rightward-shifted EDPVR. The SHapley Additive exPlanation model revealed that the variables associated with leftward-shifted EDPVR were diabetes, female sex, old age, and hypertension. CONCLUSIONS As ESLD advances, diastolic ventricular properties are characterized by increased EDVI20 and β on rightward-shifted EDPVR, indicating larger capacitance and higher stiffness. However, leftward-shifted EDPVR with left ventricle remodeling failure is associated with poor post-LT survival.
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Affiliation(s)
- Won-Jung Shin
- Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hye-Mee Kwon
- Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Hoon Kim
- Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwa-Young Jang
- Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong-Seok Park
- Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Hwan Kim
- Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyoung-Sun Kim
- Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Jin Moon
- Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In-Gu Jun
- Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun-Gol Song
- Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gyu-Sam Hwang
- Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Kim SE, Seo J, Kwon Y, Cho I, Shim CY, Ha JW, Hong GR. Effects of continuous positive airway pressure therapy on left ventricular performance in patients with severe obstructive sleep apnea. Sci Rep 2023; 13:5335. [PMID: 37005417 PMCID: PMC10067829 DOI: 10.1038/s41598-023-32274-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/24/2023] [Indexed: 04/04/2023] Open
Abstract
We investigated myocardial performance concerning obstructive sleep apnea (OSA) severity and the benefits of continuous positive airway pressure (CPAP) therapy. In this randomized sham-controlled trial, 52 patients (mean age, 49 years; 92%, males; mean AHI, 59) with severe OSA were randomly assigned to receive either CPAP or sham treatment for 3 months. The severity of OSA was determined using the apnea/hypopnea index (AHI), oxygen desaturation index (ODI), percentage of sleep time below 90% oxygen saturation (T90), and average O2 saturation during sleep (mean SpO2). We compared the changes in myocardial work after 3 months of CPAP (n = 26) versus the sham group (n = 26) at rest and during an exercise stress test. Unlike AHI or ODI, indices of hypoxemia including T90 and mean SpO2 were significantly correlated with global constructive work, as defined by work of left ventricle (LV) that contributes to LV ejection during systole (T90, β = 0.393, p = 0.012; mean SpO2, β = 0.331, p = 0.048), and global wasted work (GWW), as defined by work of LV that does not contribute to LV ejection (T90, β = 0.363, p = 0.015; mean SpO2, β = - 0.370, p = 0.019). After 3 months, GWW decreased (80.0 ± 49.2 to 60.8 ± 26.3, p = 0.009) and global work efficiency increased (94.0 ± 4.5 to 95.7 ± 2.0, p = 0.008) in the CPAP group compared to those in the sham group. At the 3-month follow-up exercise stress echocardiography, worsening of GWW during exercise was significantly decreased in the CPAP group compared to that in the sham group (p = 0.045 at 50 W). Hypoxemia indices were closely associated with myocardial performance in patients with severe OSA. CPAP treatment for 3 months improved left ventricular myocardial performance by decreasing wasted work and increasing work efficacy compared to the sham treatment.
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Affiliation(s)
- Se-Eun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Jiwon Seo
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Younghoon Kwon
- Division of Cardiology, University of Washington, Seattle, WA, 98104, USA
| | - Iksung Cho
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Chi Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Jong-Won Ha
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Geu-Ru Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Xiong FJ, Zhao W, Jia SJ, Huang XR, Luo XF, Pu HJ, Song K, Li YM. Effect of oral pre-emptive analgesia on pain management after total knee arthroplasty: a protocol for systematic review and meta-analysis. BMJ Open 2023; 13:e070998. [PMID: 36927594 PMCID: PMC10030931 DOI: 10.1136/bmjopen-2022-070998] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/07/2023] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION Total knee arthroplasty (TKA) is currently regarded as an effective treatment for knee osteoarthritis, relieving patients' pain and significantly enhancing their quality of life and activity levels, allowing them to return to work and daily life after surgery. However, some TKA patients suffer from varying degrees of postoperative residual pain and opioid abuse, which negatively impacts their recovery and quality of life. It has been reported that preoperative treatment with multimodal analgesics improves postoperative pain and reduces opioid consumption. However, there is no conclusive evidence that pre-emptive analgesia provides the same benefits in TKA. In order to inform future research, this protocol focuses on the efficacy and safety of oral analgesics used in TKA pre-emptive analgesia. METHODS AND ANALYSIS We will search the literature on the involvement of pre-emptive analgesia in the management of pain in TKA from the PubMed, EMBASE, MEDLINE, the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews, from their inception to 1 February 2023. Additionally, clinical registry platforms will be investigated to collect data for ongoing studies. Using the Cochrane Risk of Bias Tool, the quality assessment will be conducted. RevMan V.5.4 will be used for the meta-analysis. The statistic I 2 will be used to measure the percentage of total variability due to heterogeneity between studies. Where appropriate, subgroup and sensitivity analyses, assessment of evidence quality and publication bias will be conducted. ETHICS AND DISSEMINATION No ethical approval and consent is required for this systematic review. Moreover, the results of this systematic review will be disseminated through peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER CRD42022380782.
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Affiliation(s)
- Fan-Jie Xiong
- The First Affiliated Hospital of Traditional Chinese Medicine of Chengdu Medical College, Chengdu, Sichuan, China
| | - Wei Zhao
- The First Affiliated Hospital of Traditional Chinese Medicine of Chengdu Medical College, Chengdu, Sichuan, China
| | - Shi-Jian Jia
- The First Affiliated Hospital of Traditional Chinese Medicine of Chengdu Medical College, Chengdu, Sichuan, China
| | - Xiao-Rong Huang
- The First Affiliated Hospital of Traditional Chinese Medicine of Chengdu Medical College, Chengdu, Sichuan, China
| | - Xiang-Fei Luo
- The First Affiliated Hospital of Traditional Chinese Medicine of Chengdu Medical College, Chengdu, Sichuan, China
| | | | - Kai Song
- Sichuan Vocational College of Health and Rehabilitation, Zigong, Sichuan, China
| | - Yan-Ming Li
- Department of Acupuncture, The First Affiliated Hospital of Traditional Chinese Medicine of Chengdu Medical College, Chengdu, Sichuan, China
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Longitudinal Validation of Right Ventricular Pressure Monitoring for the Assessment of Right Ventricular Systolic Dysfunction in a Large Animal Ischemic Model. Crit Care Explor 2023; 5:e0847. [PMID: 36699251 PMCID: PMC9851694 DOI: 10.1097/cce.0000000000000847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Right ventricular (RV) dysfunction is a major cause of morbidity and mortality in intensive care and cardiac surgery. Early detection of RV dysfunction may be facilitated by continuous monitoring of RV waveform obtained from a pulmonary artery catheter. The objective is to evaluate the extent to which RV pressure monitoring can detect changes in RV systolic performance assess by RV end-systolic elastance (Ees) following the development of an acute RV ischemic in a porcine model. HYPOTHESIS RV pressure monitoring can detect changes in RV systolic performance assess by RV Ees following the development of an acute RV ischemic model. METHODS AND MODELS Acute ischemic RV dysfunction was induced by progressive embolization of microsphere in the right coronary artery to mimic RV dysfunction clinically experienced during cardiopulmonary bypass separation caused by air microemboli. RV hemodynamic performance was assessed using RV pressure waveform-derived parameters and RV Ees obtained using a conductance catheter during inferior vena cava occlusions. RESULTS Acute ischemia resulted in a significant reduction in RV Ees from 0.26 mm Hg/mL (interquartile range, 0.16-0.32 mm Hg/mL) to 0.14 mm Hg/mL (0.11-0.19 mm Hg/mL; p < 0.010), cardiac output from 6.3 L/min (5.7-7 L/min) to 4.5 (3.9-5.2 L/min; p = 0.007), mean systemic arterial pressure from 72 mm Hg (66-74 mm Hg) to 51 mm Hg (46-56 mm Hg; p < 0.001), and mixed venous oxygen saturation from 65% (57-72%) to 41% (35-45%; p < 0.001). Linear mixed-effect model analysis was used to assess the relationship between Ees and RV pressure-derived parameters. The reduction in RV Ees best correlated with a reduction in RV maximum first derivative of pressure during isovolumetric contraction (dP/dtmax) and single-beat RV Ees. Adjusting RV dP/dtmax for heart rate resulted in an improved surrogate of RV Ees. INTERPRETATION AND CONCLUSIONS Stepwise decreases in RV Ees during acute ischemic RV dysfunction were accurately tracked by RV dP/dtmax derived from the RV pressure waveform.
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Seemann F, Bruce CG, Khan JM, Ramasawmy R, Potersnak AG, Herzka DA, Kakareka JW, Jaimes AE, Schenke WH, O'Brien KJ, Lederman RJ, Campbell-Washburn AE. Dynamic pressure-volume loop analysis by simultaneous real-time cardiovascular magnetic resonance and left heart catheterization. J Cardiovasc Magn Reson 2023; 25:1. [PMID: 36642713 PMCID: PMC9841727 DOI: 10.1186/s12968-023-00913-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 01/05/2023] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Left ventricular (LV) contractility and compliance are derived from pressure-volume (PV) loops during dynamic preload reduction, but reliable simultaneous measurements of pressure and volume are challenging with current technologies. We have developed a method to quantify contractility and compliance from PV loops during a dynamic preload reduction using simultaneous measurements of volume from real-time cardiovascular magnetic resonance (CMR) and invasive LV pressures with CMR-specific signal conditioning. METHODS Dynamic PV loops were derived in 16 swine (n = 7 naïve, n = 6 with aortic banding to increase afterload, n = 3 with ischemic cardiomyopathy) while occluding the inferior vena cava (IVC). Occlusion was performed simultaneously with the acquisition of dynamic LV volume from long-axis real-time CMR at 0.55 T, and recordings of invasive LV and aortic pressures, electrocardiogram, and CMR gradient waveforms. PV loops were derived by synchronizing pressure and volume measurements. Linear regression of end-systolic- and end-diastolic- pressure-volume relationships enabled calculation of contractility. PV loops measurements in the CMR environment were compared to conductance PV loop catheter measurements in 5 animals. Long-axis 2D LV volumes were validated with short-axis-stack images. RESULTS Simultaneous PV acquisition during IVC-occlusion was feasible. The cardiomyopathy model measured lower contractility (0.2 ± 0.1 mmHg/ml vs 0.6 ± 0.2 mmHg/ml) and increased compliance (12.0 ± 2.1 ml/mmHg vs 4.9 ± 1.1 ml/mmHg) compared to naïve animals. The pressure gradient across the aortic band was not clinically significant (10 ± 6 mmHg). Correspondingly, no differences were found between the naïve and banded pigs. Long-axis and short-axis LV volumes agreed well (difference 8.2 ± 14.5 ml at end-diastole, -2.8 ± 6.5 ml at end-systole). Agreement in contractility and compliance derived from conductance PV loop catheters and in the CMR environment was modest (intraclass correlation coefficient 0.56 and 0.44, respectively). CONCLUSIONS Dynamic PV loops during a real-time CMR-guided preload reduction can be used to derive quantitative metrics of contractility and compliance, and provided more reliable volumetric measurements than conductance PV loop catheters.
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Affiliation(s)
- Felicia Seemann
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood, Institute, National Institutes of Health, 10 Center Drive, Building 10 Rm B1D47, Bethesda, MD, 20892, USA.
| | - Christopher G Bruce
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood, Institute, National Institutes of Health, 10 Center Drive, Building 10 Rm B1D47, Bethesda, MD, 20892, USA
| | - Jaffar M Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood, Institute, National Institutes of Health, 10 Center Drive, Building 10 Rm B1D47, Bethesda, MD, 20892, USA
| | - Rajiv Ramasawmy
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood, Institute, National Institutes of Health, 10 Center Drive, Building 10 Rm B1D47, Bethesda, MD, 20892, USA
| | - Amanda G Potersnak
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood, Institute, National Institutes of Health, 10 Center Drive, Building 10 Rm B1D47, Bethesda, MD, 20892, USA
| | - Daniel A Herzka
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood, Institute, National Institutes of Health, 10 Center Drive, Building 10 Rm B1D47, Bethesda, MD, 20892, USA
| | - John W Kakareka
- Instrumentation Development and Engineering Application Solutions, Division of Intramural Research, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Andrea E Jaimes
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood, Institute, National Institutes of Health, 10 Center Drive, Building 10 Rm B1D47, Bethesda, MD, 20892, USA
| | - William H Schenke
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood, Institute, National Institutes of Health, 10 Center Drive, Building 10 Rm B1D47, Bethesda, MD, 20892, USA
| | - Kendall J O'Brien
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood, Institute, National Institutes of Health, 10 Center Drive, Building 10 Rm B1D47, Bethesda, MD, 20892, USA
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood, Institute, National Institutes of Health, 10 Center Drive, Building 10 Rm B1D47, Bethesda, MD, 20892, USA
| | - Adrienne E Campbell-Washburn
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood, Institute, National Institutes of Health, 10 Center Drive, Building 10 Rm B1D47, Bethesda, MD, 20892, USA
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MacIver DH, Scrase T, Zhang H. Left ventricular contractance: A new measure of contractile function. Int J Cardiol 2023; 371:345-353. [PMID: 36084798 DOI: 10.1016/j.ijcard.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/02/2022] [Indexed: 12/14/2022]
Abstract
AIMS Myocardial contractility is poorly defined and difficult to compare between studies. Contractance or myocardial active strain energy density (MASED) measures the mechanical work done per unit volume (with units of kJ/m3) by any cardiac tissue during contraction. Contractance is an ideal candidate for measuring contractile function as it combines information from both stress and strain. METHODS AND RESULTS Data obtained from three previously published experimental studies using trabecular tissue was used to provide contemporaneous nominal stress and strain data in 18 different scenarios with different loading conditions. Contractance varied in the differing loading conditions with values of 1.16 (low preload), 2.02 (high afterload) and 3.76 kJ/m3 (normal). Contractance varied between 0 with isometric loading and 2.14 kJ/m3 with an isotonic and moderate afterload. Increasing inotropy increased contractance to 4.7 kJ/m3. CONCLUSION We showed that calculating MASED was feasible and provided a measure of energy production (work done) per unit volume of myocardium during contraction. The new term for contractile function, contractance, can be defined and quantified by MASED. Contractance measures contractile function in differing preload, afterload and inotropic settings. The method of measuring contractance is transferable to the assessment of global and regional systolic function.
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Affiliation(s)
- David H MacIver
- Department of Cardiology, Taunton & Somerset Hospital, United Kingdom; Biological Physics Group, Department of Astronomy and Physics, University of Manchester, Manchester, United Kingdom.
| | - Thomas Scrase
- Biological Physics Group, Department of Astronomy and Physics, University of Manchester, Manchester, United Kingdom
| | - Henggui Zhang
- Biological Physics Group, Department of Astronomy and Physics, University of Manchester, Manchester, United Kingdom
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Murali M, Turner SR, Belke DD, Cole WC, MacDonald JA. Smoothelin-like 1 knockout mice display sex-dependent alterations in blood flow and cardiac function. Can J Physiol Pharmacol 2023; 101:27-40. [PMID: 36342379 DOI: 10.1139/cjpp-2022-0172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Smoothelin-like 1 (SMTNL1) modulates the contractile performance of smooth muscle and thus has a key role in vascular homeostasis. Elevated vascular tone, recognized as a contributor to the development of progressive cardiac dysfunction, was previously found with SMTNL1 deletion. In this study, we assessed cardiac morphology and function of male and female, wild-type (Smtnl1+/+) and global SMTNL1 knockout (Smtnl1-/-) mice at 10 weeks of age. Gross dissection revealed distinct cardiac morphology only in males; Smtnl1-/- hearts were significantly smaller than Smtnl1+/+, but the left ventricle (LV) proportion of heart mass was greater. Male Smtnl1-/- mice also displayed increased ejection fraction and fractional shortening, as well as elevated aortic and pulmonary flow velocities. The impact of cardiac stress with pressure overload by transverse aortic constriction (TAC) was examined in male mice. With TAC banding, systolic function was preserved, but the LV filling pressure was selectively elevated due to relaxation impairment. Smtnl1-/- mice displayed higher early/passive filling velocity of LV/early mitral annulus velocity ratio (E/E' ratio) and myocardial performance index along with a prolonged isovolumetric relaxation time. Taken together, the findings support a novel, sex-dimorphic role for SMTNL1 in modulating cardiac structure and function of mice.
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Affiliation(s)
- Megha Murali
- Department of Biochemistry & Molecular Biology, Cumming School of Medicine,University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
| | - Sara R Turner
- Department of Biochemistry & Molecular Biology, Cumming School of Medicine,University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
| | - Darrell D Belke
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, 1403-29 Street NWCalgary, AB T2N 2T9, Canada
| | - William C Cole
- Department of Physiology & Pharmacology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| | - Justin A MacDonald
- Department of Biochemistry & Molecular Biology, Cumming School of Medicine,University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
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Zhao W, Xiong FJ, Feng SG, Li YM, Lei XH, Jia SJ. Oral Chinese patent medicines for acute myocardial infarction after percutaneous coronary intervention: A protocol for systematic review and network meta-analysis. Medicine (Baltimore) 2022; 101:e31927. [PMID: 36482597 PMCID: PMC9726348 DOI: 10.1097/md.0000000000031927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Acute myocardial infarction (AMI) is a serious and fatal heart disease with one of the highest mortality rates in the world. In some countries, percutaneous coronary intervention (PCI) is the preferred reperfusion strategy after AMI, but it cannot achieve safe and effective treatment of AMI after PCI remains a challenging clinical problem. The potential of oral Chinese patent medicines to treat AMI after PCI has been demonstrated, but which type of oral Chinese patent medicines may be preferred remains controversial. The aim of this network meta-analysis was to investigate the efficacy and safety of multiple oral Chinese patent medicines in the treatment of AMI after PCI. METHODS We will conduct a literature search from China National Knowledge Infrastructure, formerly Chinese Biomedical Database (SinoMed), Wanfang Data, Chongqing VIP, PubMed, Embase, Web of Science and Cochrane Library (The Cochrane Database of Systematic Reviews) from their inception until to November 1, 2022, with language restricted to Chinese and English. Then, the study selection process will follow the Preferred Reporting Items for Meta-Analyses guideline, and the quality assessment will be conducted with Cochrane Collaboration's tool. Pairwise and network meta-analysis will be conducted using the WinBUGS V.1.4.3.37 and STATA V.13. Additionally, sensitivity analysis, subgroup analysis, quality assessment, Small-study effects and publication bias will be performed. ETHICS AND DISSEMINATION This work is based on published research and therefore does not require ethical approval. This review will be published in peer-reviewed journals. PROSPERO REGISTRATION NUMBER CRD42020188065.
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Affiliation(s)
- Wei Zhao
- Xindu Hospital of Traditional Chinese Medicine Affiliated to Chengdu Medical College, Chengdu, China
| | - Fan-Jie Xiong
- Xindu Hospital of Traditional Chinese Medicine Affiliated to Chengdu Medical College, Chengdu, China
| | - Shu-Gui Feng
- Luzhou Traditional Chinese Medicine Hospital Affiliated to Southwest Medical University, Luzhou, China
| | - Yan-Ming Li
- Xindu Hospital of Traditional Chinese Medicine Affiliated to Chengdu Medical College, Chengdu, China
| | - Xing-Hua Lei
- Xindu Hospital of Traditional Chinese Medicine Affiliated to Chengdu Medical College, Chengdu, China
| | - Shi-Jian Jia
- Xindu Hospital of Traditional Chinese Medicine Affiliated to Chengdu Medical College, Chengdu, China
- *Correspondence: Shi-Jian Jia, Xindu Hospital of Traditional Chinese Medicine Affiliated to Chengdu Medical College, No.120 Xiangzhang Road, Xindu District, Chengdu, Sichuan Province 610500, China (e-mail: )
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